Individual
JACK J HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
619 E MASON ST STE 4P57, SPRINGFIELD, IL 62701
(217) 788-0706
(217) 525-2535
Mailing address
619 E MASON ST STE 4P57, SPRINGFIELD, IL 62701-1034
(217) 788-0706
(217) 525-2535
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
01038562A
IN
207RI0011X
Interventional Cardiology Physician
01038562A
IN
207RI0011X
Interventional Cardiology Physician
Primary
036136720
IL
207RI0011X
Interventional Cardiology Physician
129026
MT
207RI0011X
Interventional Cardiology Physician
13144
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200063500
—
IN
01
—
P01427268
RAILROAD
IL
Enumeration date
02/27/2006
Last updated
02/27/2025
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