Provider Demographics
NPI:1770649865
Name:MARTIN, E. HALE (PHD)
Entity Type:Individual
Prefix:
First Name:E.
Middle Name:HALE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 E ILIFF AVE
Mailing Address - Street 2:STE. 223
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6061
Mailing Address - Country:US
Mailing Address - Phone:303-881-3544
Mailing Address - Fax:303-757-7994
Practice Address - Street 1:4770 E ILIFF AVE
Practice Address - Street 2:STE. 223
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6061
Practice Address - Country:US
Practice Address - Phone:303-881-3544
Practice Address - Fax:303-757-7994
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2148103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68346Medicare ID - Type Unspecified