Provider Demographics
NPI:1063695948
Name:HALL, NATHANIEL LYLE (MD)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:LYLE
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 HERITAGE WAY
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3158
Mailing Address - Country:US
Mailing Address - Phone:406-257-8992
Mailing Address - Fax:406-751-4161
Practice Address - Street 1:350 HERITAGE WAY
Practice Address - Street 2:SUITE 2100
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3158
Practice Address - Country:US
Practice Address - Phone:406-257-8992
Practice Address - Fax:406-751-4161
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT6359029-1205207R00000X
NDPT12921207RI0011X
MT49679207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1063695948Medicaid
ND18320Medicaid
ND18320Medicaid
NDN719037Medicare UPIN