MEDICARE: DR. WILLIAM HALLS MD

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	151287-1205	UT

General Provider Information

NPI Number	:	1861787756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM HALLS MD

Provider Business Mailing Address
First Line	:	171 3RD AVE
Second Line	:	# 310
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-5006
Country	:	US
Telephone Number	:	801-935-1177
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 3RD AVE
Second Line	:	# 310
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-5006
Country	:	US
Telephone Number	:	801-935-1177
Fax Number	:

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

Provider Enumeration Date	:	06/18/2011
Last Update Date	:	06/18/2011

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