Provider Demographics
NPI:1063617264
Name:DALE G. HALTER, M.D.
Entity type:Organization
Organization Name:DALE G. HALTER, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:G
Authorized Official - Last Name:HALTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-266-1946
Mailing Address - Street 1:902 FROSTWOOD DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2420
Mailing Address - Country:US
Mailing Address - Phone:713-266-1946
Mailing Address - Fax:713-467-7432
Practice Address - Street 1:902 FROSTWOOD DR
Practice Address - Street 2:SUITE 208
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2420
Practice Address - Country:US
Practice Address - Phone:713-266-1946
Practice Address - Fax:713-467-7432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1029207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB23271Medicare UPIN
TX00RD39Medicare ID - Type Unspecified