Basic Information
| Provider Information | |||||||||
| NPI: | 1467616037 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NINA KEITH HALL MD PMC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 61950 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705961950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3379810305 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1825 EDWARDS ST | ||||||||
| Address2: | |||||||||
| City: | OPELOUSAS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705704777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373084199 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2008 | ||||||||
| LastUpdateDate: | 10/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | HALL | ||||||||
| AuthorizedOfficialFirstName: | NINA | ||||||||
| AuthorizedOfficialMiddleName: | KEITH | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3373084199 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.