Provider Demographics
NPI:1023632122
Name:HALL, CRAIG MATHEW
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:MATHEW
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:C.
Other - Middle Name:MATHEW
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ERM
Mailing Address - Street 1:2540 N MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3328
Mailing Address - Country:US
Mailing Address - Phone:405-779-1444
Mailing Address - Fax:
Practice Address - Street 1:2540 N MOORE AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3328
Practice Address - Country:US
Practice Address - Phone:405-779-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies