Provider Demographics
NPI:1114964970
Name:HALL, MYRON LOUIS (DPM)
Entity Type:Individual
Prefix:
First Name:MYRON
Middle Name:LOUIS
Last Name:HALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1531
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-1531
Mailing Address - Country:US
Mailing Address - Phone:323-574-3332
Mailing Address - Fax:310-858-8111
Practice Address - Street 1:9301 WILSHIRE BLVD STE 602
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-6161
Practice Address - Country:US
Practice Address - Phone:310-858-8111
Practice Address - Fax:310-858-8115
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4572213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEI096AMedicare PIN
CA6712450001Medicare NSC