Provider Demographics
NPI:1306844147
Name:HALL, SHAWN (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2647 S SAINT ELIZABETH BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5019
Mailing Address - Country:US
Mailing Address - Phone:225-765-5500
Mailing Address - Fax:225-644-5415
Practice Address - Street 1:2647 S SAINT ELIZABETH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5019
Practice Address - Country:US
Practice Address - Phone:225-765-5500
Practice Address - Fax:225-644-5415
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10010R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1970816Medicaid
E35022Medicare UPIN
5R860Medicare ID - Type Unspecified