Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0126 | OK |
Y | 222Z00000X | Podiatrist | 0126 | OK |
N | 213EP0504X | Public Medicine | 0126 | OK |
N | 213EP1101X | Primary Podiatric Medicine | 0126 | OK |
N | 111NR0200X | Radiology | 0126 | OK |
N | 213ER0200X | Radiology | 0126 | OK |
N | 2081S0010X | Sports Medicine | 0126 | OK |
N | 213ES0000X | Sports Medicine | 0126 | OK |
N | 213ES0103X | Foot & Ankle Surgery | 0126 | OK |
N | 213ES0131X | Foot Surgery | 0126 | OK |
NPI | 1962481317 |
---|---|
Provider Name | Dr. William Dale Hall |
First Address | Edmond, OK 73083-8524 |
Second Address | Del City, OK 73115-5517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 21/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
480120770 | RAILROAD MEDICARE (01) | OK |
731193914001 | BLUE CROSS BLUE SHIELD (01) | OK |
731379282 | TAX ID (01) | OK |
T40748 | (02) | OK |