Individual
DR. JERRY HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
J2046
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205320-05
—
TX
01
—
1205320-06
CSHCN
TX
01
—
8S6323
BLUE SHIELD
TX
Enumeration date
03/25/2006
Last updated
12/07/2021
Update your record
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