Provider Demographics
NPI:1619983020
Name:HALL, STEPHEN LEO (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEO
Last Name:HALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2927 PARK PLAZA LN
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-5516
Mailing Address - Country:US
Mailing Address - Phone:409-983-5178
Mailing Address - Fax:409-985-6078
Practice Address - Street 1:2927 PARK PLAZA LN
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642
Practice Address - Country:US
Practice Address - Phone:409-983-5178
Practice Address - Fax:409-983-6078
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2880207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0076NAOtherBCBS
TX7199993OtherCIGNA
TX7952158OtherAETNA
TX0076NAOtherBCBS
G95565Medicare UPIN