Provider Demographics
NPI:1679579759
Name:HALL, OTTO CHRISTIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:OTTO
Middle Name:CHRISTIAN
Last Name:HALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 98035
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70898
Mailing Address - Country:US
Mailing Address - Phone:225-766-0050
Mailing Address - Fax:225-766-1499
Practice Address - Street 1:7301 HENNESSY BLVD
Practice Address - Street 2:#200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-766-0050
Practice Address - Fax:225-766-1499
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPD027R213ES0131X
LADPMLPD027R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA06461OtherBLUE CROSS / BLUE SHEILD
LA1365661Medicaid
LA13656612Medicaid
LA06461OtherBLUE CROSS / BLUE SHEILD
LA1365661Medicaid
LA13656612Medicaid