Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 38299 | IA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 49735 | MN |
Y | 2081S0010X | Sports Medicine | 38299 | IA |
Y | 213ES0000X | Sports Medicine | 38299 | IA |
NPI | 1093836728 |
---|---|
Provider Name | Mederic Micah Hall |
First Address | Iowa City, IA 52242-8001 |
Second Address | Iowa City, IA 52242-8001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 26/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
718425000 | (05) | MN |