Healthcare Provider Details

I. General information

NPI: 1841295649
Provider Name (Legal Business Name): JOHN CHARLES HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 BROADWAY BLVD STE 316
KANSAS CITY MO
64111-3305
US

IV. Provider business mailing address

4400 BROADWAY BLVD STE 316
KANSAS CITY MO
64111-3305
US

V. Phone/Fax

Practice location:
  • Phone: 816-561-7783
  • Fax: 816-561-7968
Mailing address:
  • Phone: 816-561-7783
  • Fax: 816-561-7968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberR6868
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: