MEDICARE: CHAD G. HALL D.O.

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	207R00000X	Internal Medicine Physician	DO1729	NV

General Provider Information

NPI Number	:	1780814764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD G. HALL D.O.

Provider Business Mailing Address
First Line	:	657 N TOWN CENTER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-6367
Country	:	US
Telephone Number	:	702-450-1717
Fax Number	:

Provider Business Practice Location Address
First Line	:	11704 KINGS ARMS LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6045
Country	:	US
Telephone Number	:	801-360-6950
Fax Number	:	702-947-6740

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

Provider Enumeration Date	:	07/23/2009
Last Update Date	:	01/09/2017

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