Provider Demographics
NPI:1255412466
Name:HALL, PAMELA ELIZABETH (MD)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ELIZABETH
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:PEARSON
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:820 DELTONA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7177
Mailing Address - Country:US
Mailing Address - Phone:386-860-4545
Mailing Address - Fax:386-860-5632
Practice Address - Street 1:820 DELTONA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7177
Practice Address - Country:US
Practice Address - Phone:386-860-4545
Practice Address - Fax:386-860-5632
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45027207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05544OtherBC BS OF FLORIDA
FL046338800Medicaid
080068214OtherPALMETTO GBA MEDICARE RAI
FL046338800Medicaid
D51344Medicare UPIN