1366514135 NPI number — DR. JOHN REAGAN HALL DMD

Table of content: DR. JOHN REAGAN HALL DMD (NPI 1366514135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366514135 NPI number — DR. JOHN REAGAN HALL DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
JOHN
Provider Middle Name:
REAGAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366514135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2216 17TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GULFPORT
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39501-2901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-863-1911
Provider Business Mailing Address Fax Number:
228-863-9211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2216 17TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39501-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-863-1911
Provider Business Practice Location Address Fax Number:
228-863-9211
Provider Enumeration Date:
11/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2761-93 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)