Provider Demographics
NPI:1619963048
Name:HALE, LLOYD S (DPM)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:S
Last Name:HALE
Suffix:
Gender:M
Credentials:DPM
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 2757
Mailing Address - Street 2:
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713-1730
Mailing Address - Country:US
Mailing Address - Phone:828-488-8200
Mailing Address - Fax:828-488-8221
Practice Address - Street 1:80 BRYSON WALK
Practice Address - Street 2:
Practice Address - City:BRYSON CITY
Practice Address - State:NC
Practice Address - Zip Code:28713-8731
Practice Address - Country:US
Practice Address - Phone:828-488-8200
Practice Address - Fax:828-488-8221
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC380213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890800AMedicaid
NC0800AOtherBCBS
NC2433053JMedicare PIN
NC890800AMedicaid