MEDICARE: ROBERT L HALL, MD

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	170100000X	Ph.D. Medical Genetics	R3J38	MO

General Provider Information

NPI Number	:	1487617932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT L HALL, MD

Provider Business Mailing Address
First Line	:	2725 N WESTWOOD BLVD
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-2367
Country	:	US
Telephone Number	:	573-778-3338
Fax Number	:	573-778-3337

Provider Business Practice Location Address
First Line	:	2725 N WESTWOOD BLVD
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-2346
Country	:	US
Telephone Number	:	573-778-3338
Fax Number	:	573-778-3337

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DEE SIMPSON
Credential	:	MD
Telephone Number	:	573-778-3338

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	08/22/2020

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