Provider Demographics
NPI:1164442125
Name:HALL, PERRY EUGENE (PA)
Entity type:Individual
Prefix:MR
First Name:PERRY
Middle Name:EUGENE
Last Name:HALL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-314-4900
Mailing Address - Fax:801-314-4919
Practice Address - Street 1:5848 FASHION BLVD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6121
Practice Address - Country:US
Practice Address - Phone:801-314-4900
Practice Address - Fax:801-314-4919
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT285915-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS74154Medicare UPIN
UT000069006Medicare PIN
UT005556754Medicare PIN
UT000060573Medicare PIN
UT000063288Medicare PIN