Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 4301406147 | MI |
NPI | 1609868496 |
---|---|
Provider Name | Jeffrey Maurice Hall |
First Address | Warren, MI 48093-5266 |
Second Address | Roseville, MI 48066-5807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 06/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4163461 | (05) | MI |
F04766 | (02) | |
JH406147 | BCBS PIN # (01) | MI |