Healthcare Provider Details

I. General information

NPI: 1750322749
Provider Name (Legal Business Name): ROD HALL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35911 KENAI SPUR HWY STE 6
SOLDOTNA AK
99669-7155
US

IV. Provider business mailing address

35911 KENAI SPUR HWY STE 6
SOLDOTNA AK
99669-7155
US

V. Phone/Fax

Practice location:
  • Phone: 907-260-7729
  • Fax: 907-260-7783
Mailing address:
  • Phone: 907-260-7729
  • Fax: 907-260-7783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number4349
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number4349
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number4349
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number4349
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number4349
License Number StateAK
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4349
License Number StateAK
# 7
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4349
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: