Provider Demographics
NPI:1811046022
Name:HALE, CHARLES GORDON (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GORDON
Last Name:HALE
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 1:805 132ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2615
Mailing Address - Country:US
Mailing Address - Phone:425-462-2543
Mailing Address - Fax:425-638-0352
Practice Address - Street 1:805 132ND AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2615
Practice Address - Country:US
Practice Address - Phone:425-462-2543
Practice Address - Fax:425-638-0352
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00007089207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease