Healthcare Provider Details

I. General information

NPI: 1609875814
Provider Name (Legal Business Name): HAL MARTIN MONCIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/29/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 MAYNARDVILLE HWY
MAYNARDVILLE TN
37807-3618
US

IV. Provider business mailing address

6350 W A J HWY DEPARTMENT 100
TALBOTT TN
37877
US

V. Phone/Fax

Practice location:
  • Phone: 865-992-3849
  • Fax: 865-992-5166
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD21114
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: