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General NPI Number Information
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NPI Number | 1558741686
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Entity Type | Individual
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Provider Name | MICHELLE LYNNETTE HALL M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 03/11/2026
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Provider Practice Location Address
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Address Line | 960 BACK STAGE LN
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City | LAKE BUENA VISTA
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State | FL
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Zip | 32830-8472
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Country | US
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Telephone | 407-934-4100
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Fax | 407-934-4101
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Provider Business Mailing Address
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Address Line | 960 BACK STAGE LN
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City | LAKE BUENA VISTA
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State | FL
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Zip | 32830-8472
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Country | US
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Telephone | 407-934-4100
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Fax | 407-934-4101
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME136536
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 000000000000
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License Number State | MO
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