Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4349 | AK |
N | 207QA0401X | Family Doctor - Addiction Medicine | 4349 | AK |
N | 207QA0505X | Family Doctor - Adult Medicine | 4349 | AK |
N | 207QS0010X | Family Doctor - Sports Medicine | 4349 | AK |
N | 208D00000X | General Practice Physician | 4349 | AK |
NPI | 1750322749 |
---|---|
Provider Name | Rod Hall |
First Address | Sterling, AK 99672 |
Second Address | Sterling, AK 99672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 15/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G53192 | (02) |