Provider Demographics
NPI:1235179128
Name:WOODALL, HAL B (MD)
Entity Type:Individual
Prefix:
First Name:HAL
Middle Name:B
Last Name:WOODALL
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:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:KENLY
Mailing Address - State:NC
Mailing Address - Zip Code:27542-0275
Mailing Address - Country:US
Mailing Address - Phone:919-284-4025
Mailing Address - Fax:919-284-5965
Practice Address - Street 1:101 E 2ND ST
Practice Address - Street 2:
Practice Address - City:KENLY
Practice Address - State:NC
Practice Address - Zip Code:27542-7794
Practice Address - Country:US
Practice Address - Phone:919-284-4025
Practice Address - Fax:919-284-5965
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8989096Medicaid
NC110034167OtherRAILROAD MEDICARE
NC89096OtherBC
C87267Medicare UPIN
NC211683AMedicare PIN