Healthcare Provider Details

I. General information

NPI: 1194136812
Provider Name (Legal Business Name): MATTHEW BRIAN HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 07/01/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18780 INTERSTATE 20
CANTON TX
75103-3593
US

IV. Provider business mailing address

170 MANNING DR CB #7594
CHAPEL HILL NC
27599-7594
US

V. Phone/Fax

Practice location:
  • Phone: 903-567-4841
  • Fax:
Mailing address:
  • Phone: 919-966-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberR1214
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR1214
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: