MEDICARE: SHAWN 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	207Q00000X	Family Medicine Physician	10010R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306844147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN HALL M.D.

Provider Business Mailing Address
First Line	:	2647 S SAINT ELIZABETH BLVD STE 100
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70737-5019
Country	:	US
Telephone Number	:	225-765-5500
Fax Number	:	225-644-5415

Provider Business Practice Location Address
First Line	:	2647 S SAINT ELIZABETH BLVD STE 100
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70737-5019
Country	:	US
Telephone Number	:	225-765-5500
Fax Number	:	225-644-5415

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	03/23/2021

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