Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 0C26646 | CA |
Y | 207X00000X | Orthopaedic Surgeon | 0C26646 | CA |
NPI | 1578666491 |
---|---|
Provider Name | Dr. William R. Hale |
First Address | Pomona, CA 91767 |
Second Address | Pomona, CA 91767-3006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 21/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00266460 | (05) | CA |
00C266460 | (05) | CA |
A33173 | (02) | CA |
WC26646A | (02) | CA |