Provider Demographics
NPI:1093717613
Name:HALL, ARTHUR L (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:L
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 1:550 E STATE ROAD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750
Mailing Address - Country:US
Mailing Address - Phone:407-262-5710
Mailing Address - Fax:407-262-5796
Practice Address - Street 1:9964 UNIVERSITY BOULEVARD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817
Practice Address - Country:US
Practice Address - Phone:407-261-2956
Practice Address - Fax:407-657-0719
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45648207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274935100Medicaid
FL256255300Medicaid
FL101851OtherAVMED ID #
FL05545OtherBCBS
FL256255300Medicaid
FL05545WMedicare ID - Type Unspecified
FL101851OtherAVMED ID #
FL256255300Medicaid