Provider Demographics
NPI:1881636850
Name:HALE, STEVEN ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ANTHONY
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 1:1136 GATLIN AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-7142
Mailing Address - Country:US
Mailing Address - Phone:407-859-5675
Mailing Address - Fax:
Practice Address - Street 1:6101 LAKE ELLENOR DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4616
Practice Address - Country:US
Practice Address - Phone:407-858-1430
Practice Address - Fax:407-858-5514
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0033821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0389293-00Medicaid
FLME0033821OtherFLORIDA MEDICAL LICENSE
FL47348XMedicare PIN
FLME0033821OtherFLORIDA MEDICAL LICENSE