Provider Demographics
NPI:1467523274
Name:HALL, ERIC J (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:HALL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 E HOSPITAL DR STE 205
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-4171
Mailing Address - Country:US
Mailing Address - Phone:979-848-3068
Mailing Address - Fax:979-849-1423
Practice Address - Street 1:146 E HOSPITAL DR STE 205
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-4171
Practice Address - Country:US
Practice Address - Phone:979-848-3068
Practice Address - Fax:979-849-1423
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04176363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218818701Medicaid
TXTXB103490Medicare PIN
TX218818701Medicaid