MEDICARE: STEPHEN L. HALL, D.O., P.A.

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	207X00000X	Orthopaedic Surgery Physician	J2880	TX

General Provider Information

NPI Number	:	1679899264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN L. HALL, D.O., P.A.

Provider Business Mailing Address
First Line	:	2927 PARK PLAZA LN
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5516
Country	:	US
Telephone Number	:	409-983-5178
Fax Number	:

Provider Business Practice Location Address
First Line	:	2927 PARK PLAZA LN
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5516
Country	:	US
Telephone Number	:	409-983-5178
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MGR
Name	:	MRS. KIMBERLY M HALL
Credential	:
Telephone Number	:	409-983-5178

Provider Enumeration Date	:	04/08/2010
Last Update Date	:	01/09/2012

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