Healthcare Provider Details

I. General information

NPI: 1467708271
Provider Name (Legal Business Name): KEVIN ARTHUR HALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 JEFFERSON WAY SUITE 102
KETCHIKAN AK
99901-5953
US

IV. Provider business mailing address

25 JEFFERSON WAY STE 102B
KETCHIKAN AK
99901-5953
US

V. Phone/Fax

Practice location:
  • Phone: 907-247-7827
  • Fax: 973-215-2052
Mailing address:
  • Phone: 201-259-0289
  • Fax: 973-215-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number128432
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21312
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA09133000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: