Provider Demographics
NPI:1689891897
Name:HALL, PRUDENCE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:PRUDENCE
Middle Name:ELIZABETH
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1148 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5091
Mailing Address - Country:US
Mailing Address - Phone:310-458-7979
Mailing Address - Fax:310-458-0179
Practice Address - Street 1:1148 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5091
Practice Address - Country:US
Practice Address - Phone:310-458-7979
Practice Address - Fax:310-458-0179
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG041661207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92276Medicare UPIN