Provider Demographics
NPI:1598747735
Name:HALL, SCOTT L (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
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 1:123 17TH STREET, BRIGHAM BUILDING
Mailing Address - Street 2:MAIL STOP 316
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89577-0316
Mailing Address - Country:US
Mailing Address - Phone:775-784-1533
Mailing Address - Fax:775-784-4473
Practice Address - Street 1:123 17TH STREET, BRIGHAM BUILDING
Practice Address - Street 2:MAIL STOP 316
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89577-0316
Practice Address - Country:US
Practice Address - Phone:775-784-1533
Practice Address - Fax:775-784-4473
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12023207Q00000X
UT12860233-1205207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV12023OtherSTATE LISENCE
OH35086047OtherOHIO STATE LICENSE
OHHA7337371Medicare ID - Type UnspecifiedOHIO MEDICARE PROVIDER NO
OHI43315Medicare UPIN