Provider Demographics
NPI:1538156146
Name:HALL, PAULA ADELLE (DO)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:ADELLE
Last Name:HALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3048 SILVER PALM DR.
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141
Mailing Address - Country:US
Mailing Address - Phone:386-209-8634
Mailing Address - Fax:321-473-3689
Practice Address - Street 1:3048 SILVER PALM DR.
Practice Address - Street 2:SUITE B
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32141
Practice Address - Country:US
Practice Address - Phone:386-209-8634
Practice Address - Fax:321-473-3689
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8438207QA0505X
FL058438208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1233023Medicaid
IA1233023Medicaid
IAI1690Medicare ID - Type Unspecified