Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 12049 | TX |
NPI | 1912257361 |
---|---|
Provider Name | Dr. Bradley Allen Hall I |
First Address | Plano, TX 75024-5601 |
Second Address | Frisco, TX 75034-5869 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2012 |
Last Update Date | 04/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12049 | STATE LICENSE (01) | TX |