Provider Demographics
NPI:1912933631
Name:VAN HAL, MARVIN E (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:E
Last Name:VAN HAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:729 W BEDFORD EULESS RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-3939
Mailing Address - Country:US
Mailing Address - Phone:817-282-1012
Mailing Address - Fax:817-282-1015
Practice Address - Street 1:729 W BEDFORD EULESS RD
Practice Address - Street 2:SUITE 106
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-3939
Practice Address - Country:US
Practice Address - Phone:817-282-1012
Practice Address - Fax:817-282-1015
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH9171207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0031DFOtherBLUE CROSS BLUE SHIELD
TX180192000OtherDEPARTMENT OF LABOR
TXE64874Medicare UPIN
TX180192000OtherDEPARTMENT OF LABOR