Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 2901016896 | MI |
N | 1223G0001X | General Practice | 019.023197 | IL |
N | 213EG0000X | General Practice | 019.023197 | IL |
N | 1223G0001X | General Practice | 12011912A | IN |
N | 213EG0000X | General Practice | 12011912A | IN |
Y | 1223G0001X | General Practice | 30.020619 | OH |
Y | 213EG0000X | General Practice | 30.020619 | OH |
NPI | 1720187750 |
---|---|
Provider Name | John Leglagen Hall |
First Address | Adrian, MI 49221 |
Second Address | Adrian, MI 49221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 07/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0317521 | (05) | OH |
201134060 | (05) | IN |
420322612 | (05) | MI |