Provider Demographics
NPI:1184679326
Name:HALL, CARY (MD)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:
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 1:861 SW 78TH AVE
Mailing Address - Street 2:SUITE #100B
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3229
Mailing Address - Country:US
Mailing Address - Phone:954-693-0000
Mailing Address - Fax:954-693-0005
Practice Address - Street 1:1395 S PINELLAS AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3790
Practice Address - Country:US
Practice Address - Phone:727-942-5000
Practice Address - Fax:727-942-5121
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002026270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO150050034Medicare PIN