Provider Demographics
NPI:1184723975
Name:HALL, JON M (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:M
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-858-9400
Mailing Address - Fax:812-858-9571
Practice Address - Street 1:4015 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8925
Practice Address - Country:US
Practice Address - Phone:812-858-9400
Practice Address - Fax:812-858-9571
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050887A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000521187OtherBCBS PIN
IN200263090Medicaid
IN870350QMedicare PIN
IN257900NMedicare PIN
IN200263090Medicaid