MEDICARE: TAD ALAN HALL PA-C

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	363A00000X	Physician Assistant	377	OK

General Provider Information

NPI Number	:	1134179641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAD ALAN HALL PA-C

Provider Business Mailing Address
First Line	:	300 WANDA ST
Second Line	:
City	:	MARIETTA
State	:	OK
Zip	:	73448-1200
Country	:	US
Telephone Number	:	580-276-3347
Fax Number	:	580-276-2182

Provider Business Practice Location Address
First Line	:	300 WANDA ST
Second Line	:
City	:	MARIETTA
State	:	OK
Zip	:	73448-1200
Country	:	US
Telephone Number	:	580-276-3347
Fax Number	:	580-276-2182

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	11/21/2007

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Directions to “ TAD ALAN HALL PA-C” Practice Location

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