Healthcare Provider Details

I. General information

NPI: 1245273622
Provider Name (Legal Business Name): JENNIFER K HALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER K SEPT

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 FORT MISSOULA RD BLDG 3
MISSOULA MT
59804-7423
US

IV. Provider business mailing address

PO BOX 7609
MISSOULA MT
59807-7609
US

V. Phone/Fax

Practice location:
  • Phone: 406-721-5600
  • Fax: 406-329-7122
Mailing address:
  • Phone: 406-721-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11092
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: