Provider Demographics
NPI:1013168830
Name:HALL, BRIAN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOHN
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 N CURTIS RD
Mailing Address - Street 2:STE 117
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1336
Mailing Address - Country:US
Mailing Address - Phone:208-367-2153
Mailing Address - Fax:308-367-3991
Practice Address - Street 1:999 N CURTIS RD
Practice Address - Street 2:STE 117
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1336
Practice Address - Country:US
Practice Address - Phone:208-367-2153
Practice Address - Fax:308-367-3991
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008030582390200000X
UT7471512-1205207ZP0102X
TXBP10044759207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program