Provider Demographics
NPI:1982818233
Name:ANDREW F HALL MD
Entity Type:Organization
Organization Name:ANDREW F HALL MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:F
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-674-4449
Mailing Address - Street 1:350 S BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-0000
Mailing Address - Country:US
Mailing Address - Phone:307-674-4449
Mailing Address - Fax:307-674-6665
Practice Address - Street 1:350 S BROOKS ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-0000
Practice Address - Country:US
Practice Address - Phone:307-674-4449
Practice Address - Fax:307-674-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5984A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW307629Medicare PIN
WYG45288Medicare UPIN