Provider Demographics
NPI:1952309338
Name:HALL, DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:HALL
Suffix:
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 1:1317 SE 25TH LOOP
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6193
Mailing Address - Country:US
Mailing Address - Phone:352-629-7955
Mailing Address - Fax:352-629-3523
Practice Address - Street 1:1317 SE 25TH LOOP
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6193
Practice Address - Country:US
Practice Address - Phone:352-629-7955
Practice Address - Fax:352-629-3523
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0023619207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050615000Medicaid
FL71686OtherBCBS
D58156Medicare UPIN
FL71686OtherBCBS