Provider Demographics
NPI:1609816719
Name:HALL, JOHN P (D O)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:HALL
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4927
Mailing Address - Country:US
Mailing Address - Phone:573-334-7748
Mailing Address - Fax:573-334-5724
Practice Address - Street 1:3 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4927
Practice Address - Country:US
Practice Address - Phone:573-334-7748
Practice Address - Fax:573-334-5724
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6A29208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241417419Medicaid
MO340004582OtherRAILROAD MEDICARE
MO25537OtherBLUE CROSS BLUE SHIELD
MO0296520001OtherMEDICARE SUPPLIER (DMERC)
MO146619OtherHEALTHLINK