Provider Demographics
NPI:1962481317
Name:HALL, WILLIAM DALE (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DALE
Last Name:HALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:W.
Other - Middle Name:DALE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 8524
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-8524
Mailing Address - Country:US
Mailing Address - Phone:405-471-6190
Mailing Address - Fax:405-285-8921
Practice Address - Street 1:5480 MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-5517
Practice Address - Country:US
Practice Address - Phone:405-733-2783
Practice Address - Fax:405-741-2804
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0126213E00000X, 213EP0504X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK480120770OtherRAILROAD MEDICARE
OK731379282OtherTAX ID
OK731193914001OtherBLUE CROSS BLUE SHIELD
OK731379282OtherTAX ID
OKT40748Medicare UPIN