1760476956 NPI number — WYNTON L HALL JR. M.D.,F.A.C.S.

Table of content: WYNTON L HALL JR. M.D.,F.A.C.S. (NPI 1760476956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760476956 NPI number — WYNTON L HALL JR. M.D.,F.A.C.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
WYNTON
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.,F.A.C.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760476956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 BRYAN RD
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33511-5337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-681-7512
Provider Business Mailing Address Fax Number:
813-684-8974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 BRYAN RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
BRANDON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33511-5337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-681-7512
Provider Business Practice Location Address Fax Number:
813-684-8974
Provider Enumeration Date:
09/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  ME35424 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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