Provider Demographics
NPI:1508847112
Name:HALL, RALPH WARREN (DO)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:WARREN
Last Name:HALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:403 WOODLAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-8798
Mailing Address - Country:US
Mailing Address - Phone:620-223-8040
Mailing Address - Fax:620-223-8002
Practice Address - Street 1:403 WOODLAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-8798
Practice Address - Country:US
Practice Address - Phone:620-223-8013
Practice Address - Fax:620-223-8524
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0522858208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSF59070Medicare UPIN
KS54392Medicare PIN