Basic Information
| Provider Information | |||||||||
| NPI: | 1437177540 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | BERT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 226 | ||||||||
| Address2: | |||||||||
| City: | ARGYLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762260226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9404643066 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 325 OLD JUSTIN RD | ||||||||
| Address2: | BOX 226 | ||||||||
| City: | ARGYLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762263514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729343200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 06/09/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2867 | OK | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | L0239 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0068PJ | 01 | TX | BCBS | OTHER | 141964012 | 05 | TX | MEDICAID | 141964014 | 05 | TX | MEDICAID | 8F7254 | 01 | TX | BCBS | OTHER |