Provider Demographics
NPI:1205809357
Name:HALE, TYSON DARWIN (MD)
Entity type:Individual
Prefix:
First Name:TYSON
Middle Name:DARWIN
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:PO BOX 293531
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-3531
Mailing Address - Country:US
Mailing Address - Phone:830-896-5206
Mailing Address - Fax:830-896-5211
Practice Address - Street 1:164 INSPIRATION LOOP
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-8409
Practice Address - Country:US
Practice Address - Phone:830-997-1268
Practice Address - Fax:830-997-1382
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD235012085R0202X
TXL22982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147549303Medicaid
TX147549303Medicaid
TX8D8193Medicare ID - Type Unspecified