Provider Demographics
NPI:1588625511
Name:HALL, JEANNE M (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:3190 S WADSWORTH BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-4800
Mailing Address - Country:US
Mailing Address - Phone:303-904-0976
Mailing Address - Fax:303-948-5318
Practice Address - Street 1:3190 S WADSWORTH BLVD STE 250
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-4800
Practice Address - Country:US
Practice Address - Phone:303-904-0976
Practice Address - Fax:303-948-5318
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061001A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200526580AMedicaid
IN200526580AMedicaid
H30581Medicare UPIN