Provider Demographics
NPI:1194878314
Name:HALL, MARIE ELAINE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ELAINE
Last Name:HALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:204 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4822
Mailing Address - Country:US
Mailing Address - Phone:361-664-0145
Mailing Address - Fax:
Practice Address - Street 1:502 E. SAN PATRICIO
Practice Address - Street 2:
Practice Address - City:MATHIS
Practice Address - State:TX
Practice Address - Zip Code:78368-2266
Practice Address - Country:US
Practice Address - Phone:361-547-4121
Practice Address - Fax:361-547-4132
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02743363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286003302Medicaid
TXP70971Medicare UPIN
TX8L22850Medicare Oscar/Certification