Healthcare Provider Details

I. General information

NPI: 1326466830
Provider Name (Legal Business Name): ERIC HALL D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

IV. Provider business mailing address

1905 BLAKE AVE STE 201
GLENWOOD SPRINGS CO
81601-4286
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-7921
  • Fax: 317-415-7922
Mailing address:
  • Phone: 970-947-9999
  • Fax: 970-947-9226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number02005996A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number390200000
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0058274
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: