Provider Demographics
NPI:1518986884
Name:HALES, WALTER J (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:J
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 1:6703 W RIO GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2623
Mailing Address - Country:US
Mailing Address - Phone:509-946-6144
Mailing Address - Fax:509-783-5438
Practice Address - Street 1:821 SWIFT BOULEVARD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7623
Practice Address - Country:US
Practice Address - Phone:509-946-6144
Practice Address - Fax:509-946-7253
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031184207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
116834OtherLABOR & INDUSTRIES
WA1084268Medicaid
WAAB01870Medicare ID - Type Unspecified
A02442Medicare UPIN
WA1084268Medicaid
1259080001Medicare NSC
AB01870Medicare PIN