MEDICARE: PEYTON R 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	207V00000X	Obstetrics & Gynecology Physician	012274	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	:	1508869801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEYTON R HALL M.D.

Provider Business Mailing Address
First Line	:	312 GRAMMONT ST
Second Line	:	SUITE 300
City	:	MONROE
State	:	LA
Zip	:	71201-7457
Country	:	US
Telephone Number	:	318-388-4030
Fax Number	:	318-324-3334

Provider Business Practice Location Address
First Line	:	417 MCMILLAN RD
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-5325
Country	:	US
Telephone Number	:	318-322-7119
Fax Number	:	318-325-8475

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/21/2022

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