Provider Demographics
NPI:1689668824
Name:HALL, MICHAEL SPENCER (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SPENCER
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 1:2650 BAHIA VISTA ST
Mailing Address - Street 2:STE 207
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2625
Mailing Address - Country:US
Mailing Address - Phone:941-366-8960
Mailing Address - Fax:941-364-9111
Practice Address - Street 1:2650 BAHIA VISTA ST
Practice Address - Street 2:STE 207
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2625
Practice Address - Country:US
Practice Address - Phone:941-366-8960
Practice Address - Fax:941-364-9111
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38184207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D64522Medicare UPIN
FL58338Medicare ID - Type Unspecified