Provider Demographics
NPI:1639193360
Name:HALL, DONALD O (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:O
Last Name:HALL
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:820 PRUDENTIAL DR STE 713
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8209
Mailing Address - Country:US
Mailing Address - Phone:904-396-5682
Mailing Address - Fax:904-346-0864
Practice Address - Street 1:7487 S STATE ROAD 121
Practice Address - Street 2:NORTHEAST FLORIDA STATE HOSPITAL
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-5451
Practice Address - Country:US
Practice Address - Phone:904-396-5682
Practice Address - Fax:904-346-0864
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
FLOS2329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE76170Medicare UPIN