Provider Demographics
NPI:1619979812
Name:LONDON, HAL (DO)
Entity type:Individual
Prefix:DR
First Name:HAL
Middle Name:
Last Name:LONDON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15328
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32035-3106
Mailing Address - Country:US
Mailing Address - Phone:904-556-9593
Mailing Address - Fax:
Practice Address - Street 1:1203 N 3RD ST
Practice Address - Street 2:
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537-1303
Practice Address - Country:US
Practice Address - Phone:904-556-9593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9096207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271550300Medicaid
FL50108OtherBCBS
FL50108BMedicare ID - Type Unspecified