Provider Demographics
NPI:1528196573
Name:HALL, EDWARD ANTHONY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ANTHONY
Last Name:HALL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:ED
Other - Middle Name:ANTHONY
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:13601 WINDWARD CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-3436
Mailing Address - Country:US
Mailing Address - Phone:907-345-9365
Mailing Address - Fax:
Practice Address - Street 1:800 CORDOVA ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3717
Practice Address - Country:US
Practice Address - Phone:907-222-7612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK329363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant