Provider Demographics
NPI:1528273067
Name:HALL, JEFFREY WARREN (LMT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:WARREN
Last Name:HALL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96014 SEA WINDS DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-8500
Mailing Address - Country:US
Mailing Address - Phone:904-261-8448
Mailing Address - Fax:
Practice Address - Street 1:2382 SADLER RD
Practice Address - Street 2:ST 1
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4548
Practice Address - Country:US
Practice Address - Phone:904-261-0622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA8605174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist