Individual
MRS. JHON R HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
13176 W PERSIMMON LANE, BOISE, ID 83713
(208) 939-8640
(208) 939-1892
Mailing address
13176 W PERSIMMON LANE, BOISE, ID 83713
(208) 939-8640
(208) 939-1892
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
M5446
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23812
BLUE SHIELD
—
01
—
82800
BLUE CROSS
—
Enumeration date
11/06/2006
Last updated
07/08/2007
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