Healthcare Provider Details

I. General information

NPI: 1225225261
Provider Name (Legal Business Name): JARED AARON HALL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 S WHITE MOUNTAIN RD BLDG A
SHOW LOW AZ
85901-7827
US

IV. Provider business mailing address

2200 E SHOW LOW LAKE RD
SHOW LOW AZ
85901-7831
US

V. Phone/Fax

Practice location:
  • Phone: 928-537-6700
  • Fax: 928-532-2169
Mailing address:
  • Phone: 928-537-6393
  • Fax: 928-532-2131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0667
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: