MEDICARE: DAVID EARL HALL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	ME43210	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00240895	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0130316	OTHER	FL	GHI
2	5451200001	OTHER	FL	CIGNA GOVERNMENT SERVICES
4	62480	OTHER	FL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1043202583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID EARL HALL M.D.

Provider Business Mailing Address
First Line	:	6950 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33707-1210
Country	:	US
Telephone Number	:	727-343-3004
Fax Number	:	727-345-0454

Provider Business Practice Location Address
First Line	:	6950 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33707-1210
Country	:	US
Telephone Number	:	727-343-3004
Fax Number	:	727-345-0454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	11/23/2009

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Directions to “ DAVID EARL HALL M.D.” Practice Location

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