Provider Demographics
NPI:1659311454
Name:HALL, JOAHN JESSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAHN
Middle Name:JESSE
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOAHN
Other - Middle Name:JESSE
Other - Last Name:HODGES-BETTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7800 PASEO BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1859
Mailing Address - Country:US
Mailing Address - Phone:816-523-3055
Mailing Address - Fax:816-523-3070
Practice Address - Street 1:7800 PASEO BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1859
Practice Address - Country:US
Practice Address - Phone:816-523-3055
Practice Address - Fax:816-523-3070
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9H66207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSE03984Medicare UPIN