Provider Demographics
NPI:1639197841
Name:HALL, RICHARD EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EUGENE
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 1:8029 CREST DR NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5217
Mailing Address - Country:US
Mailing Address - Phone:206-523-7090
Mailing Address - Fax:206-523-7255
Practice Address - Street 1:12911 120TH AVE NE
Practice Address - Street 2:SUITE C-40
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3027
Practice Address - Country:US
Practice Address - Phone:425-899-6333
Practice Address - Fax:425-899-4243
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033967207X00000X, 207XX0005X
NE18328207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Not Answered207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG31545Medicare UPIN