Healthcare Provider Details

I. General information

NPI: 1508834409
Provider Name (Legal Business Name): TERRY E. HALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 MILLER ST.
BETHANY MO
64424-0233
US

IV. Provider business mailing address

PO BOX 233
BETHANY MO
64424-0233
US

V. Phone/Fax

Practice location:
  • Phone: 660-425-7443
  • Fax: 660-425-6516
Mailing address:
  • Phone: 660-425-7443
  • Fax: 660-425-6516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberR6D52
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: