1629051941 NPI number — RYAN C. W. HALL, MD, PA

Table of content: (NPI 1629051941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629051941 NPI number — RYAN C. W. HALL, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RYAN C. W. HALL, MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RICHARD CW. HALL, M.D, PA
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629051941
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 W LAKE MARY BLVD STE 219
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE MARY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32746-3501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-322-8199
Provider Business Mailing Address Fax Number:
407-322-8169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 W LAKE MARY BLVD STE 219
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE MARY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32746-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-322-8199
Provider Business Practice Location Address Fax Number:
407-322-8169
Provider Enumeration Date:
11/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
CHALONER WINTON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-322-8199

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  ME0014470 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: 013895 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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