Healthcare Provider Details

I. General information

NPI: 1225128986
Provider Name (Legal Business Name): DEBORAH K. HALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 GOLF CLUB RD SE SUITE 204
LACEY WA
98503-1048
US

IV. Provider business mailing address

PO BOX 1166
EVERETT WA
98206-1166
US

V. Phone/Fax

Practice location:
  • Phone: 360-493-7469
  • Fax:
Mailing address:
  • Phone: 425-258-7357
  • Fax: 425-258-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00024641
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: