Provider Demographics
NPI:1982915575
Name:HALL-JASPER, JAMIE LEANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LEANN
Last Name:HALL-JASPER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:LEANN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:100 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3323
Mailing Address - Country:US
Mailing Address - Phone:304-896-5012
Mailing Address - Fax:304-896-5013
Practice Address - Street 1:100 MAIN AVE
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3323
Practice Address - Country:US
Practice Address - Phone:304-896-5012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2015-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10421213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery