Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | DR.0054751 | CO |
N | 207NS0135X | Procedural Dermatology | DR.0054751 | CO |
N | 208D00000X | General Practice Physician | UO2792 | FL |
NPI | 1104106053 |
---|---|
Provider Name | Dr. Jamie Hale |
First Address | Boulder, CO 80301-3324 |
Second Address | Boulder, CO 80301-3324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2011 |
Last Update Date | 18/03/2015 |