Provider Demographics
NPI:1407915663
Name:HALE, ALICE A (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:A
Last Name:HALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4881 SUGAR MAPLE DR
Mailing Address - Street 2:SGOH
Mailing Address - City:WPAFB
Mailing Address - State:OH
Mailing Address - Zip Code:45433-5546
Mailing Address - Country:US
Mailing Address - Phone:937-257-6877
Mailing Address - Fax:937-986-1192
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:SGOH
Practice Address - City:WPAFB
Practice Address - State:OH
Practice Address - Zip Code:45433-5546
Practice Address - Country:US
Practice Address - Phone:937-257-6877
Practice Address - Fax:937-986-1192
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH350509842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2012961Medicare ID - Type Unspecified