Provider Demographics
NPI:1902808439
Name:HALL, RANDALL STANTON (DO)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:STANTON
Last Name:HALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 S MAIN ST STE 200
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-7028
Mailing Address - Country:US
Mailing Address - Phone:817-912-8060
Mailing Address - Fax:817-912-8070
Practice Address - Street 1:601 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-7028
Practice Address - Country:US
Practice Address - Phone:817-912-8060
Practice Address - Fax:817-912-8070
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3673207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150872302Medicaid
TX150872301Medicaid
TX8CA479OtherBCBS
TX349459YMNTMedicare PIN
TXG44436Medicare UPIN