Provider Demographics
NPI:1639251531
Name:HALES, STANLEY E (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
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 1:1200 N 14TH AVE STE 300B
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4166
Mailing Address - Country:US
Mailing Address - Phone:509-545-1492
Mailing Address - Fax:509-545-0601
Practice Address - Street 1:1200 N 14TH AVE STE 300B
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4166
Practice Address - Country:US
Practice Address - Phone:509-545-1492
Practice Address - Fax:509-545-0601
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA19871174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1922608Medicaid
WA00030069Medicare ID - Type Unspecified
WA1922608Medicaid