MEDICARE: MR. JEFFREY WARREN HALL LMT

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	174400000X	Specialist	MA8605	FL

General Provider Information

NPI Number	:	1528273067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY WARREN HALL LMT

Provider Business Mailing Address
First Line	:	96014 SEA WINDS DR
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-8500
Country	:	US
Telephone Number	:	904-261-8448
Fax Number	:

Provider Business Practice Location Address
First Line	:	2382 SADLER RD
Second Line	:	ST 1
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4548
Country	:	US
Telephone Number	:	904-261-0622
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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