Individual
DR. EDWIN BACON HALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1709 GIRARD BLVD NE, ALBUQUERQUE, NM 87106-1718
(505) 268-4588
(505) 262-2778
Mailing address
1709 GIRARD BLVD NE, ALBUQUERQUE, NM 87106-1718
(505) 268-4588
(505) 262-2778
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
NM75161
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NM100071
—
NM
Enumeration date
04/17/2006
Last updated
07/09/2007
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