Provider Demographics
NPI:1972789170
Name:MARK E HALL D P M P A
Entity type:Organization
Organization Name:MARK E HALL D P M P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-966-5060
Mailing Address - Street 1:7556 LAKE WORTH RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2503
Mailing Address - Country:US
Mailing Address - Phone:561-966-5060
Mailing Address - Fax:561-966-4489
Practice Address - Street 1:7556 LAKE WORTH RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2503
Practice Address - Country:US
Practice Address - Phone:561-966-5060
Practice Address - Fax:561-966-4489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02108332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4629090001Medicare NSC
FLT81578Medicare UPIN