Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 09147 | MS |
NPI | 1023032497 |
---|---|
Provider Name | Dr. Hal T Liddell |
First Address | Hattiesburg, MS 39402-1303 |
Second Address | Hattiesburg, MS 39402-1303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 04/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023032497 | (05) | MS |
509218YTSR | MEDICARE PTAN (01) | MS |
B64475 | (02) | MS |