Provider Demographics
NPI:1164483566
Name:HALL, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:HALL
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 1:1025 MICHIGAN AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1665
Mailing Address - Country:US
Mailing Address - Phone:574-722-3566
Mailing Address - Fax:574-753-6118
Practice Address - Street 1:1025 MICHIGAN AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1665
Practice Address - Country:US
Practice Address - Phone:574-722-3566
Practice Address - Fax:574-753-6118
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026249A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000523882OtherANTHEM BLUE CROSS
IN100070560Medicaid
IN100070560AMedicaid
IN111880BMedicare ID - Type Unspecified
IN100070560Medicaid
IN940670ZZZZMedicare PIN