=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841533726
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK E HALL DPM P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2013
-----------------------------------------------------
Last Update Date | 03/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6080 BOYNTON BEACH BLVD SUITE 100
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33437-3588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-375-6700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6080 BOYNTON BEACH BLVD SUITE 100
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33437-3588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-375-6700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INSURANCE REP
-----------------------------------------------------
Name | MRS. JIMMIE MATHIS-LEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-966-5060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------