Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 18797 | KY |
NPI | 1104394857 |
---|---|
Provider Name | George Scott Hall SR. |
First Address | Fernandina Beach, FL 32034-6413 |
Second Address | Fernandina Beach, FL 32034-6413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2018 |
Last Update Date | 09/11/2018 |