Provider Demographics
NPI:1003993064
Name:HALL, TERRENCE J (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:J
Last Name:HALL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 E 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:COQUILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97423-1666
Mailing Address - Country:US
Mailing Address - Phone:541-396-3101
Mailing Address - Fax:541-396-1783
Practice Address - Street 1:940 E 5TH STREET
Practice Address - Street 2:
Practice Address - City:COQUILLE
Practice Address - State:OR
Practice Address - Zip Code:97423-1666
Practice Address - Country:US
Practice Address - Phone:541-396-3101
Practice Address - Fax:541-396-1783
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069953208600000X
ORMD175340208600000X
IL036-0699532086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214881Medicare Oscar/Certification
IL214881Medicare Oscar/Certification