Provider Demographics
NPI:1851369185
Name:HALE, SAMUEL ANDREW JR
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ANDREW
Last Name:HALE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 SLIDE ROAD
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424
Mailing Address - Country:US
Mailing Address - Phone:806-794-6886
Mailing Address - Fax:806-783-0709
Practice Address - Street 1:6809 SLIDE ROAD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424
Practice Address - Country:US
Practice Address - Phone:806-794-6886
Practice Address - Fax:806-783-0709
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-11
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C16451Medicare UPIN