Provider Demographics
NPI:1891776027
Name:HALES, EARL MCCAJAH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:MCCAJAH
Last Name:HALES
Suffix:
Gender:M
Credentials:PA-C
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:1255 LILA ST
Practice Address - Street 2:UFJAX - FAMILY MEDICINE AT LEM TURNER
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3550
Practice Address - Country:US
Practice Address - Phone:904-244-5700
Practice Address - Fax:904-244-5791
Is Sole Proprietor?:No
Enumeration Date:2005-11-05
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA1810363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011695800Medicaid
FLP00054494OtherRAILROAD
GA168512696AMedicaid
FL011695800Medicaid
GA168512696AMedicaid
FLS58926Medicare UPIN
FLE0955SMedicare PIN
FLE0955VMedicare PIN