Healthcare Provider Details

I. General information

NPI: 1154736833
Provider Name (Legal Business Name): AMANDA BROOKE HALL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2014
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 HARMON RD STE 141
FORT WORTH TX
76177-7521
US

IV. Provider business mailing address

833 TOWNE CT
SAGINAW TX
76179-1280
US

V. Phone/Fax

Practice location:
  • Phone: 817-306-5630
  • Fax: 817-306-5631
Mailing address:
  • Phone: 817-306-5630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10044541
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ1988
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: