MEDICARE: DR. MARK E HALL D.P.M. P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	P02108	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	65220	OTHER	FL	BC/BS OF FL
3	65-0960025	OTHER	FL	TAX ID #
4	P02108	OTHER	FL	FLORIDA LICENSE #

General Provider Information

NPI Number	:	1104899764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK E HALL D.P.M. P.A.

Provider Business Mailing Address
First Line	:	7556 LAKE WORTH RD
Second Line	:	SUITE 104
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2503
Country	:	US
Telephone Number	:	561-966-5060
Fax Number	:	561-966-4489

Provider Business Practice Location Address
First Line	:	7556 LAKE WORTH RD
Second Line	:	SUITE 104
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2503
Country	:	US
Telephone Number	:	561-966-5060
Fax Number	:	561-966-4489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	01/14/2011

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