Provider Demographics
NPI:1629211891
Name:HALE, JUSTIN SANDERS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:SANDERS
Last Name:HALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:543 CHALAN GUMA YUOS ST
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3630
Mailing Address - Country:US
Mailing Address - Phone:671-649-4764
Mailing Address - Fax:671-649-4765
Practice Address - Street 1:543 CHALAN GUMA YUOS ST
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3630
Practice Address - Country:US
Practice Address - Phone:671-649-4764
Practice Address - Fax:671-649-4765
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1615762084N0400X, 2084S0012X
GUM-18472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine