Provider Demographics
NPI:1578654083
Name:HALL, DAVID CLINTON (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CLINTON
Last Name:HALL
Suffix:
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 1:1000 SE 13TH CT
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7857
Mailing Address - Country:US
Mailing Address - Phone:479-273-9056
Mailing Address - Fax:479-273-6937
Practice Address - Street 1:1000 SE 13TH CT
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7857
Practice Address - Country:US
Practice Address - Phone:479-273-9056
Practice Address - Fax:479-273-6937
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-6416207Q00000X
SC15966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC83969223Medicare PIN
SC159660Medicaid