Provider Demographics
NPI:1720149974
Name:HALL, A DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:A
Middle Name:DAVID
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 1:12 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:CAMMACK VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72207-1822
Mailing Address - Country:US
Mailing Address - Phone:501-664-2185
Mailing Address - Fax:
Practice Address - Street 1:12 SUNSET DR
Practice Address - Street 2:
Practice Address - City:CAMMACK VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:72207-1822
Practice Address - Country:US
Practice Address - Phone:501-664-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-4823208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARD79462Medicare UPIN