Individual
JASON HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1965 S FREMONT AVE, STE 230, SPRINGFIELD, MO 65804-2201
(417) 820-7250
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
RR MEDICARE
MO
05
—
PENDING
—
AR
05
—
PENDING
—
MO
Enumeration date
02/17/2016
Last updated
02/17/2016
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