Healthcare Provider Details

I. General information

NPI: 1780840504
Provider Name (Legal Business Name): MARSHALL HALL III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10778 FRENCH CREEK RD
PALO CEDRO CA
96073-9527
US

IV. Provider business mailing address

10778 FRENCH CREEK RD
PALO CEDRO CA
96073-9527
US

V. Phone/Fax

Practice location:
  • Phone: 530-549-3201
  • Fax: 530-549-3584
Mailing address:
  • Phone: 530-549-3201
  • Fax: 530-549-3584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA24856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: