Provider Demographics
NPI:1043202583
Name:HALL, DAVID EARL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EARL
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1210
Mailing Address - Country:US
Mailing Address - Phone:727-343-3004
Mailing Address - Fax:727-345-0454
Practice Address - Street 1:6950 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1210
Practice Address - Country:US
Practice Address - Phone:727-343-3004
Practice Address - Fax:727-345-0454
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43210207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0130316OtherGHI
FL5451200001OtherCIGNA GOVERNMENT SERVICES
FLP00240895OtherRAILROAD MEDICARE
FL62480OtherBLUE CROSS/BLUE SHIELD
FLP00240895OtherRAILROAD MEDICARE
FL62480XMedicare ID - Type Unspecified