Provider Demographics
NPI:1083716245
Name:HALL, III, THOMAS BRYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BRYAN
Last Name:HALL, III
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD.
Mailing Address - Street 2:4070 DELP MAIL STOP 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-7816
Mailing Address - Country:US
Mailing Address - Phone:913-588-6400
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-7341
Practice Address - Country:US
Practice Address - Phone:913-588-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-175832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO08597039OtherBCBS KANSAS CITY
MO08597039OtherBCBS KANSAS CITY
0614454AMedicare ID - Type Unspecified