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NPI Code Detail

MEDICARE: MR. DWIGHT M HALL CRNA

MEDICARE: MR. DWIGHT M HALL CRNA
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
1367500000XCertified Registered Nurse Anesthetist47045TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
185006UOTHERTXBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770582736
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DWIGHT M HALL CRNA
Provider Business Mailing Address
First Line : 1110 TURNER DR
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-6750
Country : US
Telephone Number : 903-720-1459
Fax Number : 903-720-1459
Provider Business Practice Location Address
First Line : 300 WILSON ST
Second Line :
City : HENDERSON
State : TX
Zip : 75652-5956
Country : US
Telephone Number : 903-657-7541
Fax Number : 903-596-7541
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2005
Last Update Date : 04/03/2014

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