Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 17804 | AZ |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 17804 | AZ |
NPI | 1043282247 |
---|---|
Provider Name | Donald D Hales |
First Address | Flagstaff, AZ 86001-1391 |
Second Address | Flagstaff, AZ 86001-1398 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 02/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E77216 | (02) | AR |