Provider Demographics
NPI:1578531992
Name:HALL, L.V. JR (IDC)
Entity Type:Individual
Prefix:
First Name:L.V.
Middle Name:
Last Name:HALL
Suffix:JR
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS SAMUEL B. ROBERTS (FFG 58)
Mailing Address - Street 2:FPO AA
Mailing Address - City:MAYPORT
Mailing Address - State:FL
Mailing Address - Zip Code:34092-1512
Mailing Address - Country:US
Mailing Address - Phone:904-270-6230
Mailing Address - Fax:
Practice Address - Street 1:USS SAMUEL B. ROBERTS (FFG 58)
Practice Address - Street 2:FPO AA
Practice Address - City:MAYPORT
Practice Address - State:FL
Practice Address - Zip Code:34092-1512
Practice Address - Country:US
Practice Address - Phone:904-270-6230
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman