Provider Demographics
NPI:1790885358
Name:HALE, DOUGLAS S (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
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 1:600 BROADWAY
Mailing Address - Street 2:STE 220
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5395
Mailing Address - Country:US
Mailing Address - Phone:206-344-3808
Mailing Address - Fax:206-860-0907
Practice Address - Street 1:600 BROADWAY STE 220
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5373
Practice Address - Country:US
Practice Address - Phone:206-344-3808
Practice Address - Fax:206-860-0907
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP427213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA480012743OtherRAILROAD MEDICARE
WA1069566Medicaid
WA0701340001Medicare NSC
WA000108715Medicare PIN
WA1069566Medicaid