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NPI Code Detail

MEDICARE: DR. RANDON TRENERE HALL M.D.

MEDICARE: DR. RANDON TRENERE HALL M.D.
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
1390200000XStudent in an Organized Health Care Education/Training Program
2208000000XPediatrics Physician35.098811OH
32080S0010XPediatric Sports Medicine Physician47929AZ

General Provider Information

NPI Number : 1942473749
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDON TRENERE HALL M.D.
Provider Business Mailing Address
First Line : 3200 E CAMELBACK RD
Second Line : STE 250
City : PHOENIX
State : AZ
Zip : 85018-2327
Country : US
Telephone Number : 602-933-1813
Fax Number :
Provider Business Practice Location Address
First Line : 1919 E THOMAS RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-7710
Country : US
Telephone Number : 602-933-3033
Fax Number : 602-933-5245
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2008
Last Update Date : 03/20/2018

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