MEDICARE: KIMBERLY 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	MD206479	OR

General Provider Information

NPI Number	:	1851786495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY HALL

Provider Business Mailing Address
First Line	:	1200 NE 48TH AVE STE 1100
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-5062
Country	:	US
Telephone Number	:	503-844-8219
Fax Number	:	503-844-8234

Provider Business Practice Location Address
First Line	:	1200 NE 48TH AVE STE 1100
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-5062
Country	:	US
Telephone Number	:	503-844-8219
Fax Number	:	503-844-8234

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

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	12/01/2021

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Directions to “ KIMBERLY HALL ” Practice Location

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