MEDICARE: MRS. PAULA ADELLE HALL D.O.

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	207QA0505X	Adult Medicine Physician	OS8438	FL
2	208D00000X	General Practice Physician	058438	FL

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	:	1538156146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAULA ADELLE HALL D.O.

Provider Business Mailing Address
First Line	:	3048 SILVER PALM DR.
Second Line	:	SUITE B
City	:	EDGEWATER
State	:	FL
Zip	:	32141
Country	:	US
Telephone Number	:	386-209-8634
Fax Number	:	321-473-3689

Provider Business Practice Location Address
First Line	:	3048 SILVER PALM DR.
Second Line	:	SUITE B
City	:	EDGEWATER
State	:	FL
Zip	:	32141
Country	:	US
Telephone Number	:	386-209-8634
Fax Number	:	321-473-3689

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	03/22/2023

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