Individual
CORY T HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1139 3RD ST, SOUTH LAKE TAHOE, CA 96150-3465
(530) 541-3100
(530) 541-3016
Mailing address
PO BOX 529, ZEPHYR COVE, NV 89448-0529
(775) 588-8938
(775) 588-8930
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA15806
CA
363A00000X
Physician Assistant
PA678
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC1490
BCBS
NV
Enumeration date
11/03/2005
Last updated
11/16/2007
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