Basic Information
Provider Information
NPI: 1144666025
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HALE
FirstName: SETH
MiddleName: M.
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5323 HARRY HINES BLVD
Address2:  
City: DALLAS
State: TX
PostalCode: 753907201
CountryCode: US
TelephoneNumber: 2146457521
FaxNumber:  
Practice Location
Address1: 5323 HARRY HINES BLVD
Address2:  
City: DALLAS
State: TX
PostalCode: 753905000
CountryCode: US
TelephoneNumber: 2146483111
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/17/2013
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XR4556TXN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
390200000X4301102892MIN Student, Health CareStudent in an Organized Health Care Education/Training Program 
207R00000XR4556TXY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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