Provider Demographics
NPI:1235343070
Name:HALL, PATRICK B (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:B
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 1:7301 HENNESSY BLVD #200
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808
Mailing Address - Country:US
Mailing Address - Phone:225-766-0050
Mailing Address - Fax:225-766-1499
Practice Address - Street 1:7301 HENNESSY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-766-0050
Practice Address - Fax:225-766-1499
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001054213ES0103X
LADPM200013213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1309648Medicaid
LA1309648Medicaid
LA4N276CW83Medicare PIN