Provider Demographics
NPI:1447232764
Name:HALES, ROBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:HALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 STOCKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1419
Mailing Address - Country:US
Mailing Address - Phone:916-734-2960
Mailing Address - Fax:916-734-3384
Practice Address - Street 1:2230 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1419
Practice Address - Country:US
Practice Address - Phone:916-734-2960
Practice Address - Fax:916-734-3384
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0369932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G369930Medicaid
CAF15079Medicare UPIN