Provider Demographics
NPI:1093700346
Name:HALL, ANTHONY JAMES (MD,CM,FACS,CIME)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JAMES
Last Name:HALL
Suffix:
Gender:M
Credentials:MD,CM,FACS,CIME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 S STATE ROAD 7 STE 4
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6721
Mailing Address - Country:US
Mailing Address - Phone:954-459-4600
Mailing Address - Fax:954-459-3333
Practice Address - Street 1:1685 S STATE ROAD 7 STE 4
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33023-6721
Practice Address - Country:US
Practice Address - Phone:954-459-4600
Practice Address - Fax:954-459-3333
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67040207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140007991OtherRAILROAD MEDICARE
FL264899700Medicaid
FL27319SMedicare PIN
FL140007991OtherRAILROAD MEDICARE
FLG10843Medicare UPIN