MEDICARE: HUGH RYAN 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	213ES0103X	Foot & Ankle Surgery Podiatrist	0640	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952352619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUGH RYAN HALL DPM

Provider Business Mailing Address
First Line	:	4830 HIGHWAY 260 STE 103
Second Line	:
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5851
Country	:	US
Telephone Number	:	928-532-5227
Fax Number	:	928-532-1129

Provider Business Practice Location Address
First Line	:	4830 HIGHWAY 260 STE 103
Second Line	:
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5851
Country	:	US
Telephone Number	:	928-532-5227
Fax Number	:	928-532-1129

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	10/10/2019

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