Provider Demographics
NPI:1922072446
Name:HALL, EDWARD JASON (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JASON
Last Name:HALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:406 E ELM ST
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811
Mailing Address - Country:US
Mailing Address - Phone:989-584-3131
Mailing Address - Fax:989-584-6734
Practice Address - Street 1:1014 E WASHINGTON
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838
Practice Address - Country:US
Practice Address - Phone:616-754-7145
Practice Address - Fax:616-754-7110
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101014725207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4592581Medicaid
MI080195443OtherRAILROAD MEDICARE PTAN
MI4592581Medicaid
MI080195443OtherRAILROAD MEDICARE PTAN