Healthcare Provider Details

I. General information

NPI: 1760122311
Provider Name (Legal Business Name): JAID NICOLE HALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5788 ECKHERT RD UNIT 5
SAN ANTONIO TX
78240-3900
US

IV. Provider business mailing address

SAUSHEC PSYCHIATRY RESIDENCY WILFORD HALL MEDICAL CENTE 1100 WILFORD HALL LOOP
LACKLAND TX
78236
US

V. Phone/Fax

Practice location:
  • Phone: 214-668-7495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberU9938
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: