Provider Demographics
NPI:1457533846
Name:HALL, HUGH JR (MD)
Entity type:Individual
Prefix:
First Name:HUGH
Middle Name:
Last Name:HALL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:703 MCDOWELL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2651
Mailing Address - Country:US
Mailing Address - Phone:502-349-1212
Mailing Address - Fax:502-349-1216
Practice Address - Street 1:703 MCDOWELL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2651
Practice Address - Country:US
Practice Address - Phone:502-349-1212
Practice Address - Fax:502-349-1216
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY26930207Q00000X
OH35.056242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000050161OtherANTHEM
KYP01003558OtherMCR RAILROAD- NCMA
KY000000711250OtherANTHEM- NCMA
KY1055781OtherPASSPORT
KY125580OtherSIHO- NCMA
KY64269301Medicaid
KY000057120COtherHUMANA- CMA
KY50033018OtherPASSPORT- NCMA
KYE14151OtherUPIN
IN201059710Medicaid
IN201059710Medicaid
KY1865901Medicare PIN