Healthcare Provider Details

I. General information

NPI: 1124134325
Provider Name (Legal Business Name): MICHAEL BRANDON HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: M BRANDON HALL MD

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N TRIUMPH BLVD
LEHI UT
84043-4999
US

IV. Provider business mailing address

1055 N 500 W ATTN: CREDENTIALING
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 801-429-8000
  • Fax: 801-766-5792
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21959
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3127391205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: