=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215935671
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RANDALL WAYNE HALL D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2005
-----------------------------------------------------
Last Update Date | 09/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 326 HIGHLAND PARK DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40475-3487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-623-3550
-----------------------------------------------------
Fax | 859-623-3393
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 326 HIGHLAND PARK DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40475-3487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-623-3550
-----------------------------------------------------
Fax | 859-623-3393
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 274
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 244161
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------