Healthcare Provider Details

I. General information

NPI: 1750962569
Provider Name (Legal Business Name): BRYAN DAVID ROBERT HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 PIPER ST STE T300
ANCHORAGE AK
99508-4685
US

IV. Provider business mailing address

3841 PIPER ST STE T300
ANCHORAGE AK
99508-4685
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-3103
  • Fax: 907-561-1862
Mailing address:
  • Phone: 907-563-3103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number252538
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: