Provider Demographics
NPI:1861761652
Name:HALE, ROGER ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:ALLEN
Last Name:HALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 LAKEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-4237
Mailing Address - Country:US
Mailing Address - Phone:937-778-9010
Mailing Address - Fax:937-312-2237
Practice Address - Street 1:104 LAKEWOOD PL
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-4237
Practice Address - Country:US
Practice Address - Phone:937-778-9010
Practice Address - Fax:937-312-2237
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047329207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology