Provider Demographics
NPI:1881676898
Name:HALL, JONATHAN S (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:S
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:603 7TH ST S
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4719
Mailing Address - Country:US
Mailing Address - Phone:727-893-6667
Mailing Address - Fax:727-528-5942
Practice Address - Street 1:603 7TH ST S
Practice Address - Street 2:SUITE 500
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4719
Practice Address - Country:US
Practice Address - Phone:727-893-6667
Practice Address - Fax:727-528-5942
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME93949207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28654ZMedicare ID - Type Unspecified
I40379Medicare UPIN