Provider Demographics
NPI:1316499809
Name:COLIN L,. HALES, MD PLLC
Entity type:Organization
Organization Name:COLIN L,. HALES, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-983-2035
Mailing Address - Street 1:3758 PARK PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-5541
Mailing Address - Country:US
Mailing Address - Phone:409-983-2035
Mailing Address - Fax:409-982-6513
Practice Address - Street 1:3758 PARK PLAZA CIR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-5541
Practice Address - Country:US
Practice Address - Phone:409-983-2035
Practice Address - Fax:409-982-6513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC16455Medicare UPIN