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General NPI Number Information
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NPI Number | 1235101270
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Entity Type | Individual
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Provider Name | FREDERICK HALL PA
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Gender | Male
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 2727 WINKLER AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-9358
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Country | US
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Telephone | 239-939-8434
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Fax |
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Provider Business Mailing Address
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Address Line | 2317 SW 43RD LN
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City | CAPE CORAL
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State | FL
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Zip | 33914-3500
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Country | US
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Telephone | 239-945-1890
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9101624
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License Number State | FL
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