Provider Demographics
NPI:1619966371
Name:HALL, ERIC E (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:E
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 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:2006 MOORES LN
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1840
Practice Address - Country:US
Practice Address - Phone:903-792-6944
Practice Address - Fax:903-792-6213
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1615207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00LB97OtherBCBS
TX122152503Medicaid
AR83393OtherBCBS
AR107681001Medicaid
OK100152100BMedicaid
TX122152505Medicaid
TX00LB97OtherBCBS
AR107681001Medicaid