Basic Information
| Provider Information | |||||||||
| NPI: | 1851312318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALE | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11720 | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863041720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287715470 | ||||||||
| FaxNumber: | 9287715471 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 SW ABBEY ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973654820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412652244 | ||||||||
| FaxNumber: | 5415744736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 08/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD7612 | HI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD28757 | OR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD7612 | HI | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 56228 | AZ | Y | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | MD28757 | OR | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 072841 01 | 05 | HI | MEDICAID | 9939444 | 01 | HI | UHA - STRAUB | OTHER | 00C0094700 | 01 | HI | HMSA - STRAUB | OTHER |