MEDICARE: DALENOR R. HALLS P.A.-C

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	363AM0700X	Medical Physician Assistant	1497	AZ

General Provider Information

NPI Number	:	1538183413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALENOR R. HALLS P.A.-C

Provider Business Mailing Address
First Line	:	1425 S GREENFIELD RD
Second Line	:	101
City	:	MESA
State	:	AZ
Zip	:	85206-5529
Country	:	US
Telephone Number	:	480-981-3000
Fax Number	:	480-325-3614

Provider Business Practice Location Address
First Line	:	1425 S GREENFIELD RD
Second Line	:	101
City	:	MESA
State	:	AZ
Zip	:	85206-5529
Country	:	US
Telephone Number	:	480-981-3000
Fax Number	:	480-325-3614

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	11/17/2009

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