Basic Information
| Provider Information | |||||||||
| NPI: | 1972578219 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6405 N FEDERAL HWY | ||||||||
| Address2: | 205 | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333081412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547722411 | ||||||||
| FaxNumber: | 9547723766 | ||||||||
| Practice Location | |||||||||
| Address1: | 6405 N FEDERAL HWY | ||||||||
| Address2: | 205 | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333081412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547722411 | ||||||||
| FaxNumber: | 9547723766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 07/11/2013 | ||||||||
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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 | 207R00000X | ME77622 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 257268100 | 05 | FL | MEDICAID |