Provider Demographics
NPI:1649231200
Name:HALL, JOSEPH N (DPM,FACFAS)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:N
Last Name:HALL
Suffix:
Gender:M
Credentials:DPM,FACFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16708 BOTHELL EVERETT HWY
Mailing Address - Street 2:#204
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1500
Mailing Address - Country:US
Mailing Address - Phone:425-482-6663
Mailing Address - Fax:425-482-6665
Practice Address - Street 1:16708 BOTHELL EVERETT HWY
Practice Address - Street 2:#204
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1500
Practice Address - Country:US
Practice Address - Phone:425-482-6663
Practice Address - Fax:425-482-6665
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000593213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU73094Medicare UPIN
WA4863020001Medicare NSC
WAGAB28266Medicare PIN