Individual
TIMOTHY S HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1025 MICHIGAN AVE, SUITE 115, LOGANSPORT, IN 46947-1665
(574) 722-3566
(574) 753-6118
Mailing address
1025 MICHIGAN AVE, SUITE 115, LOGANSPORT, IN 46947-1665
(574) 722-3566
(574) 753-6118
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01072086A
IN
207V00000X
Obstetrics & Gynecology Physician
9600933
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000804357
ANTHEM
IN
05
—
201131010
—
IN
05
—
8938668
—
NC
01
—
CH3883
RAIL ROAD MEDICARE
—
01
—
P01168138
RAIL ROAD
IN
Enumeration date
07/27/2006
Last updated
08/12/2013
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