Provider Demographics
NPI:1922029164
Name:HALL, YVONNE D (MD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:D
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:D
Other - Last Name:HALL-GOMEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2003 SOUTHERN BLVD SE
Mailing Address - Street 2:STE 102-214
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3751
Mailing Address - Country:US
Mailing Address - Phone:505-515-3982
Mailing Address - Fax:505-792-6060
Practice Address - Street 1:1005 21ST ST SE
Practice Address - Street 2:STE 7
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4030
Practice Address - Country:US
Practice Address - Phone:505-515-3982
Practice Address - Fax:505-792-6060
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-05912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry