Provider Demographics
NPI:1679629455
Name:HALL, RICHARD ALVIN (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALVIN
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 1:4674 HILL ST
Mailing Address - Street 2:
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-1009
Mailing Address - Country:US
Mailing Address - Phone:989-872-4725
Mailing Address - Fax:989-872-1245
Practice Address - Street 1:4674 HILL ST
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-1009
Practice Address - Country:US
Practice Address - Phone:989-872-4725
Practice Address - Fax:989-872-1245
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5790132OtherBLUE CARE NETWORK
MI0857901324OtherBLUE CROSS BLUE SHIELD
MI4111993Medicaid
MI0857901324OtherBLUE CROSS BLUE SHIELD
MI0M82780Medicare ID - Type Unspecified
MI4111993Medicaid