Provider Demographics
NPI:1770660748
Name:HALL, MONICA C (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:C
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:C
Other - Last Name:DELLIMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:201 EXECUTIVE CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4536
Mailing Address - Country:US
Mailing Address - Phone:501-224-5658
Mailing Address - Fax:501-224-8114
Practice Address - Street 1:201 EXECUTIVE CT
Practice Address - Street 2:SUITE A
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4536
Practice Address - Country:US
Practice Address - Phone:501-224-5658
Practice Address - Fax:501-224-8114
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3766207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150705001Medicaid
ARH95642Medicare UPIN
AR150705001Medicaid