Provider Demographics
NPI:1164743415
Name:HALL, TYLER J (DO)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:J
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 1:230 HOSPITAL PLZ
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-8558
Mailing Address - Country:US
Mailing Address - Phone:304-269-8100
Mailing Address - Fax:304-269-8090
Practice Address - Street 1:230 HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-8558
Practice Address - Country:US
Practice Address - Phone:304-269-8100
Practice Address - Fax:304-269-8090
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2544207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810025150Medicaid
WV3810025150Medicaid