Provider Demographics
NPI:1841295649
Name:HALL, JOHN CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:HALL
Suffix:
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 1:4400 BROADWAY BLVD STE 316
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3305
Mailing Address - Country:US
Mailing Address - Phone:816-561-7783
Mailing Address - Fax:816-561-7968
Practice Address - Street 1:4400 BROADWAY BLVD STE 316
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3305
Practice Address - Country:US
Practice Address - Phone:816-561-7783
Practice Address - Fax:816-561-7968
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6868207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS39420OtherBCBS OF KANSAS
MO06573011OtherBLUE CROSS BLUE SHIELD MO
MOR6868OtherMO STATE ID #
MO200429900Medicaid
KS100185650AMedicaid
MOR6868OtherMO STATE ID #