Provider Demographics
NPI:1104932367
Name:HALL, M KENNY (MD)
Entity type:Individual
Prefix:DR
First Name:M
Middle Name:KENNY
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARVIN
Other - Middle Name:KENNETH
Other - Last Name:HALL
Other - Suffix:III
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:405 E PINECREST DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-7200
Mailing Address - Country:US
Mailing Address - Phone:903-938-8581
Mailing Address - Fax:903-938-9409
Practice Address - Street 1:405 E PINECREST DR UNIT A
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-7200
Practice Address - Country:US
Practice Address - Phone:903-938-8581
Practice Address - Fax:903-938-9409
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0418174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8400J0OtherBLUE CROSS
TX127807905Medicaid
TX127807905Medicaid
TXB89934Medicare UPIN