Provider Demographics
NPI:1467708271
Name:HALL, KEVIN ARTHUR (MD)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ARTHUR
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:748 MILLER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901
Mailing Address - Country:US
Mailing Address - Phone:201-259-0289
Mailing Address - Fax:973-215-2052
Practice Address - Street 1:25 JEFFERSON WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5953
Practice Address - Country:US
Practice Address - Phone:907-247-7827
Practice Address - Fax:973-215-2052
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ21312208D00000X
NJ25MA09133000208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1671637Medicaid