Healthcare Provider Details

I. General information

NPI: 1891963674
Provider Name (Legal Business Name): O C HALL DPM LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 BLUEBONNET BLVD SUITE 3100
BATON ROUGE LA
70810
US

IV. Provider business mailing address

8080 BLUEBONNET BLVD SUITE 3100
BATON ROUGE LA
70810-7827
US

V. Phone/Fax

Practice location:
  • Phone: 225-408-6600
  • Fax:
Mailing address:
  • Phone: 225-408-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License NumberLPD027R
License Number StateLA

VIII. Authorized Official

Name: DR. O C HALL
Title or Position: DPM
Credential: DPM
Phone: 225-408-6600