Provider Demographics
NPI:1558573568
Name:HALL, EUGENE L (LMP)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:L
Last Name:HALL
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WILLIAM WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2500
Mailing Address - Country:US
Mailing Address - Phone:360-419-7000
Mailing Address - Fax:360-424-7969
Practice Address - Street 1:1601 WILLIAM WAY
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2500
Practice Address - Country:US
Practice Address - Phone:360-419-7000
Practice Address - Fax:360-424-7969
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA7851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist