Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 01041382A | IN |
NPI | 1386623254 |
---|---|
Provider Name | Dr. Douglass Stuart Hale |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-1261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 18/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100321840 | (05) | IN |
F57912 | (02) | IN |