Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 01022184A | IN |
NPI | 1003810656 |
---|---|
Provider Name | Ronald R Hall |
First Address | Fort Wayne, IN 46802-5257 |
Second Address | Fort Wayne, IN 46802-5257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 20/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100379340 | (05) | IN |