Provider Demographics
NPI:1952368870
Name:HALL, RICHARD SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SCOTT
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1210
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38503-1210
Mailing Address - Country:US
Mailing Address - Phone:931-520-1414
Mailing Address - Fax:931-520-1246
Practice Address - Street 1:112 N WALNUT AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2554
Practice Address - Country:US
Practice Address - Phone:931-520-1414
Practice Address - Fax:931-520-1246
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18375207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3073355Medicaid
TN3073355Medicaid
TN3073356Medicare ID - Type Unspecified