Provider Demographics
NPI:1871662437
Name:HALL, WINTHROP H JR (MD)
Entity Type:Individual
Prefix:
First Name:WINTHROP
Middle Name:H
Last Name:HALL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ROWLAND WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5055
Mailing Address - Country:US
Mailing Address - Phone:415-897-3070
Mailing Address - Fax:415-897-5485
Practice Address - Street 1:165 ROWLAND WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5055
Practice Address - Country:US
Practice Address - Phone:415-897-3070
Practice Address - Fax:415-897-5485
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC25895207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C258950Medicaid
CA00C258950Medicaid
CAAU974Medicare UPIN
00C258950Medicare ID - Type Unspecified
CA00C258950Medicaid