Provider Demographics
NPI:1639428766
Name:HALL, JERALD VICTOR (RADIOLOGY TECHNOLOGI)
Entity type:Individual
Prefix:
First Name:JERALD
Middle Name:VICTOR
Last Name:HALL
Suffix:
Gender:M
Credentials:RADIOLOGY TECHNOLOGI
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3477 PINECLIFFE AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5326
Mailing Address - Country:US
Mailing Address - Phone:970-962-9915
Mailing Address - Fax:
Practice Address - Street 1:1024 S LEMAY AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3929
Practice Address - Country:US
Practice Address - Phone:970-495-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist