Basic Information
| Provider Information | |||||||||
| NPI: | 1811931934 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | ALICE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 783324822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3616640145 | ||||||||
| FaxNumber: | 3616610422 | ||||||||
| Practice Location | |||||||||
| Address1: | 621 E SINTON ST | ||||||||
| Address2: | |||||||||
| City: | SINTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3613644486 | ||||||||
| FaxNumber: | 3613647385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 08/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 02742 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 286009002 | 05 | TX | MEDICAID |