Provider Demographics
NPI:1598764045
Name:HALL, GRAHAM TREVOR (MD)
Entity Type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:TREVOR
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 1:7959 BROADWAY ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2667
Mailing Address - Country:US
Mailing Address - Phone:210-826-7033
Mailing Address - Fax:210-805-9523
Practice Address - Street 1:7959 BROADWAY ST
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2667
Practice Address - Country:US
Practice Address - Phone:210-826-7033
Practice Address - Fax:210-805-9523
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4379208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4295135OtherAETNA
TX00F60MOtherBLUE CROSS BLUE SHIELD
TX00F60MOtherBLUE CROSS BLUE SHIELD