Provider Demographics
NPI:1225107386
Name:HALL, JHON R (MD)
Entity Type:Individual
Prefix:MRS
First Name:JHON
Middle Name:R
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13176 W PERSIMMON LANE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713
Mailing Address - Country:US
Mailing Address - Phone:208-939-8640
Mailing Address - Fax:208-939-1892
Practice Address - Street 1:13176 W PERSIMMON LANE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713
Practice Address - Country:US
Practice Address - Phone:208-939-8640
Practice Address - Fax:208-939-1892
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5446207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
23812OtherBLUE SHIELD
82800OtherBLUE CROSS
23812OtherBLUE SHIELD
D38136Medicare UPIN