Provider Demographics
NPI:1851312318
Name:HALE, STEPHEN MARK (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARK
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 11720
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-1720
Mailing Address - Country:US
Mailing Address - Phone:928-771-5470
Mailing Address - Fax:928-771-5471
Practice Address - Street 1:930 SW ABBEY ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4820
Practice Address - Country:US
Practice Address - Phone:541-265-2244
Practice Address - Fax:541-574-4736
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD7612207R00000X, 208M00000X
ORMD28757207R00000X, 208M00000X
AZ56228208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI072841 01Medicaid
HI9939444OtherUHA - STRAUB
HI00C0094700OtherHMSA - STRAUB
HI00C0094700OtherHMSA - STRAUB
HI9939444OtherUHA - STRAUB
HI53865Medicare ID - Type UnspecifiedSTRAUB