Provider Demographics
NPI:1952352619
Name:HALL, HUGH RYAN (DPM)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:RYAN
Last Name:HALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:H
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:4830 HIGHWAY 260 STE 103
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-5851
Mailing Address - Country:US
Mailing Address - Phone:928-532-5227
Mailing Address - Fax:928-532-1129
Practice Address - Street 1:4830 HIGHWAY 260 STE 103
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-5851
Practice Address - Country:US
Practice Address - Phone:928-532-5227
Practice Address - Fax:928-532-1129
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0640213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ087223Medicaid
AZ087223Medicaid
AZ087223Medicaid