Provider Demographics
NPI:1750322749
Name:HALL, ROD (DO)
Entity Type:Individual
Prefix:
First Name:ROD
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:AK
Mailing Address - Zip Code:99672
Mailing Address - Country:US
Mailing Address - Phone:907-260-7729
Mailing Address - Fax:907-260-7783
Practice Address - Street 1:34924 STERLING HIGHWAY
Practice Address - Street 2:BLDG B
Practice Address - City:STERLING
Practice Address - State:AK
Practice Address - Zip Code:99672
Practice Address - Country:US
Practice Address - Phone:907-260-7729
Practice Address - Fax:907-260-7783
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK4349207Q00000X, 207QA0000X, 207QA0401X, 207QA0505X, 207QB0002X, 207QS0010X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G53192Medicare UPIN