Provider Demographics
NPI:1689995722
Name:HALL, BRYAN J (DPM)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:J
Last Name:HALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1501 N CAMPBELL AVE RM 4402
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-0001
Mailing Address - Country:US
Mailing Address - Phone:520-626-6670
Mailing Address - Fax:520-626-4038
Practice Address - Street 1:1625 N. CAMPBELL AVE
Practice Address - Street 2:TOWER 4, 4TH FLOOR, ROOM 4402
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719
Practice Address - Country:US
Practice Address - Phone:520-626-6670
Practice Address - Fax:520-621-4038
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36.003650213ES0103X, 213E00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0086272Medicaid