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General NPI Number Information
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NPI Number | 1699904458
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Entity Type | Organization
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Legal Business Name | JARED A HALL DPM PC
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 08/26/2020
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Provider Practice Location Address
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Address Line | 5171 S CUB LAKE RD STE B230
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City | SHOW LOW
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State | AZ
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Zip | 85901-7882
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Country | US
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Telephone | 928-537-4111
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Fax | 928-537-4111
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Provider Business Mailing Address
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Address Line | 5171 S CUB LAKE RD STE B230
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City | SHOW LOW
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State | AZ
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Zip | 85901-7882
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Country | US
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Telephone | 928-537-4111
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Fax | 928-532-1123
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Authorized Official
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Title or Position | PRESIDENT
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Name | JARED A HALL
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Credential | DPM
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Telephone | 928-537-4111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0667
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License Number State | AZ
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