Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | Q9821 | TX |
NPI | 1396002606 |
---|---|
Provider Name | Michael Hall |
First Address | Austin, TX 78746-5640 |
Second Address | Walnut Creek, CA 94598-2544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2012 |
Last Update Date | 14/08/2020 |