Provider Demographics
NPI:1205882420
Name:HALL, COREY M (MD)
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:M
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 1:2013 CENTRAL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70807-3918
Mailing Address - Country:US
Mailing Address - Phone:225-774-1120
Mailing Address - Fax:225-774-1158
Practice Address - Street 1:2013 CENTRAL RD
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-3918
Practice Address - Country:US
Practice Address - Phone:225-774-1120
Practice Address - Fax:225-774-1158
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14754R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA01-02516OtherUNITED HEALTH CARE
LA2000199OtherAETNA
LA1140651Medicaid
LA4E665Medicare ID - Type Unspecified
LA1140651Medicaid