Provider Demographics
NPI:1972943785
Name:HALL, PHILLIP BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:BRADLEY
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:680 GENESIS BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9135
Mailing Address - Country:US
Mailing Address - Phone:304-933-1030
Mailing Address - Fax:304-933-1006
Practice Address - Street 1:680 GENESIS BLVD
Practice Address - Street 2:STE 201
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9135
Practice Address - Country:US
Practice Address - Phone:304-933-1030
Practice Address - Fax:304-933-1006
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
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Provider Licenses
StateLicense IDTaxonomies
WV15899207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine