Provider Demographics
NPI:1639152416
Name:HALL, JOHN R (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:HALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18626 HARDY OAK BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4228
Mailing Address - Country:US
Mailing Address - Phone:210-495-9047
Mailing Address - Fax:210-293-3901
Practice Address - Street 1:9150 HUEBNER RD STE 290
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-614-6432
Practice Address - Fax:210-615-3586
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4179207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122147505Medicaid
0025ACOtherMEDICARE LEGACY
TXF92650Medicare UPIN
TX0025ACMedicare PIN