MEDICARE: DR. JOHN CHARLES HALL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	R6868	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39420	OTHER	KS	BCBS OF KANSAS
2	06573011	OTHER	MO	BLUE CROSS BLUE SHIELD MO
3	R6868	OTHER	MO	MO STATE ID #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841295649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CHARLES HALL MD

Provider Business Mailing Address
First Line	:	4400 BROADWAY BLVD STE 316
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3305
Country	:	US
Telephone Number	:	816-561-7783
Fax Number	:	816-561-7968

Provider Business Practice Location Address
First Line	:	4400 BROADWAY BLVD STE 316
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3305
Country	:	US
Telephone Number	:	816-561-7783
Fax Number	:	816-561-7968

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	09/12/2022

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