Healthcare Provider Details

I. General information

NPI: 1164572715
Provider Name (Legal Business Name): SUSAN J P HALL, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 W J ST A
TEHACHAPI CA
93561-1311
US

IV. Provider business mailing address

PO BOX 2357
TEHACHAPI CA
93581-2357
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-4421
  • Fax:
Mailing address:
  • Phone: 661-822-4421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA76766
License Number StateCA

VIII. Authorized Official

Name: SUSAN J.P. HALL
Title or Position: PRACTICE OWNER
Credential: M.D.
Phone: 661-822-4421