MEDICARE: DR. HERBERT E HALL III D.O.

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	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	13305	MO
2	207P00000X	Emergency Medicine Physician	113305	MO
3	207Q00000X	Family Medicine Physician	113305	MO

General Provider Information

NPI Number	:	1902802754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERBERT E HALL III D.O.

Provider Business Mailing Address
First Line	:	258 NE TUDOR RD
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-5696
Country	:	US
Telephone Number	:	816-525-8086
Fax Number	:	816-525-8089

Provider Business Practice Location Address
First Line	:	258 NE TUDOR RD
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-5696
Country	:	US
Telephone Number	:	816-525-8086
Fax Number	:	816-525-8089

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	10/28/2021

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