Individual
LUKE TYLER HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1407 LOCUST ST, ELDORADO, IL 62930
(618) 273-3361
Mailing address
1201 PINE ST, ELDORADO, IL 62930-1634
(314) 531-6351
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036128470
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036128470
—
IL
Enumeration date
06/07/2007
Last updated
07/08/2018
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