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General NPI Number Information
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NPI Number | 1528061058
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Entity Type | Individual
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Provider Name | MICHAEL D HALL M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/30/2005
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Last Update Date | 11/13/2012
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Provider Practice Location Address
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Address Line | 95 JUDGE TANNER BLVD
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City | COVINGTON
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State | LA
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Zip | 70433-7500
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Country | US
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Telephone | 985-867-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 681 BOCAGE LN
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City | MANDEVILLE
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State | LA
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Zip | 70471-1605
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Country | US
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Telephone | 985-792-5537
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 025011
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License Number State | LA
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