Individual
MITCHELL GLEN HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
500 W BROADWAY ST FL 5, MISSOULA, MT 59802-4096
(406) 329-5866
Mailing address
PO BOX 31001, PASADENA, CA 91110-4110
(406) 329-5866
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
MED-PAC-LIC-131239
MT
363AS0400X
Surgical Physician Assistant
PT956
WY
Other
Enumeration date
10/04/2021
Last updated
12/09/2025
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