Provider Demographics
NPI:1548580806
Name:HALE, LUANNE YANG (MD)
Entity Type:Individual
Prefix:
First Name:LUANNE
Middle Name:YANG
Last Name:HALE
Suffix:
Gender:F
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:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:5018 DR PHILLIPS BLVD
Practice Address - Street 2:NEMOURS CHILDRENS URGENT CARE, WINDERMERE
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-3310
Practice Address - Country:US
Practice Address - Phone:407-363-5753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124105208000000X
VA0116022415390200000X
VA0101253861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015658300Medicaid
FL015658300Medicaid