Provider Demographics
NPI:1851740658
Name:HALE, PHILLIP NATHAN (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:NATHAN
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 1:9215 E 500 S
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84317-9749
Mailing Address - Country:US
Mailing Address - Phone:801-745-2290
Mailing Address - Fax:
Practice Address - Street 1:9215 E 500 S
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84317-9749
Practice Address - Country:US
Practice Address - Phone:801-745-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT150898-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology