Provider Demographics
NPI:1558573709
Name:HALL, DAVID W II (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:HALL
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3421
Mailing Address - Country:US
Mailing Address - Phone:765-289-7444
Mailing Address - Fax:765-289-8628
Practice Address - Street 1:2525 W UNIVERSITY AVE
Practice Address - Street 2:SUITE 504
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3421
Practice Address - Country:US
Practice Address - Phone:765-289-7444
Practice Address - Fax:765-289-8628
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT190290208800000X
IN01070936A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201096650Medicaid
INM400074410OtherMEDICARE