Provider Demographics
NPI:1780814764
Name:HALL, CHAD G (DO)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:G
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 1:657 N TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-6367
Mailing Address - Country:US
Mailing Address - Phone:702-450-1717
Mailing Address - Fax:
Practice Address - Street 1:11704 KINGS ARMS LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-6045
Practice Address - Country:US
Practice Address - Phone:801-360-6950
Practice Address - Fax:702-947-6740
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine