Provider Demographics
NPI:1861456543
Name:HALL, ROBERT K (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:HALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 E BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2129
Mailing Address - Country:US
Mailing Address - Phone:954-467-8554
Mailing Address - Fax:954-467-0119
Practice Address - Street 1:1211 E BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2129
Practice Address - Country:US
Practice Address - Phone:954-467-8554
Practice Address - Fax:954-467-0119
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 845213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041150700Medicaid
FL041150700Medicaid