MEDICARE: ASHLEY HALL

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	207R00000X	Internal Medicine Physician	OS18210	FL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1750843140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY HALL

Provider Business Mailing Address
First Line	:	1001 NW 13TH ST STE 201
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33486-2269
Country	:	US
Telephone Number	:	561-955-6663
Fax Number	:	561-955-2879

Provider Business Practice Location Address
First Line	:	7301A W PALMETTO PARK RD STE 100B
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3403
Country	:	US
Telephone Number	:	561-955-5761
Fax Number	:

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

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	06/17/2022

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Directions to “ ASHLEY HALL ” Practice Location

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