Provider Demographics
NPI:1972553311
Name:HALL, ERIC GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:GREGORY
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 1:640 SE OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2317
Mailing Address - Country:US
Mailing Address - Phone:772-287-2448
Mailing Address - Fax:772-287-1838
Practice Address - Street 1:640 SE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2317
Practice Address - Country:US
Practice Address - Phone:772-287-2448
Practice Address - Fax:772-287-1838
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052912174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE66567Medicare UPIN