Healthcare Provider Details

I. General information

NPI: 1467648923
Provider Name (Legal Business Name): JOHN C HALL M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15808 RANCH ROAD 620 N SUITE 100
AUSTIN TX
78717-4923
US

IV. Provider business mailing address

15808 RANCH ROAD 620 N SUITE 100
AUSTIN TX
78717-4923
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-3554
  • Fax: 512-244-2942
Mailing address:
  • Phone: 512-244-3554
  • Fax: 512-244-2942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL1058
License Number StateTX

VIII. Authorized Official

Name: JOHN C HALL
Title or Position: M.D.
Credential: M.D.
Phone: 512-244-3554