MEDICARE: SHANE OLIVER HALL DPM

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	390200000X	Student in an Organized Health Care Education/Training Program
2	213ES0103X	Foot & Ankle Surgery Podiatrist	E6153	CA

General Provider Information

NPI Number	:	1821732363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE OLIVER HALL DPM

Provider Business Mailing Address
First Line	:	1320 TARA HILLS DR STE 103
Second Line	:
City	:	PINOLE
State	:	CA
Zip	:	94564-2536
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 TARA HILLS DR STE 103
Second Line	:
City	:	PINOLE
State	:	CA
Zip	:	94564-2536
Country	:	US
Telephone Number	:	925-979-8313
Fax Number	:

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

Provider Enumeration Date	:	04/21/2022
Last Update Date	:	04/21/2026

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Directions to “ SHANE OLIVER HALL DPM” Practice Location

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