Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 3099 | TX |
NPI | 1861429789 |
---|---|
Provider Name | Dr. Marty Jay Hall |
First Address | Mansfield, TX 76063-5400 |
Second Address | Mansfield, TX 76063-5400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 20/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10032196 | (05) | TX |
T13627 | (02) | TX |