Provider Demographics
NPI:1154316305
Name:HALL, DAVID DEAN (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DEAN
Last Name:HALL
Suffix:
Gender:M
Credentials:DO
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 230310
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-0310
Mailing Address - Country:US
Mailing Address - Phone:334-272-3889
Mailing Address - Fax:334-272-4089
Practice Address - Street 1:6324 WOODMERE BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2537
Practice Address - Country:US
Practice Address - Phone:334-272-3889
Practice Address - Fax:334-272-4089
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000089942Medicaid
AL000089942Medicaid
B84904Medicare UPIN