| Doctor Name: | JACK E HALL |
| NPI Number: | 1619284239 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA |
| License Number: | 535 |
| Business Practice Address: | 121 S Crescent Dr Pueblo West, CO - 810075434 |
| Business Phone Number: | 7195957575 |
| Business Fax Number: | 7195478368 |
| Mailing Address: | Po Box 560825, DENVER |
| State: | CO |
| Postal Code: | 802560825 |
| Phone Number: | 7195957580 |
| Fax Number: | 7195450176 |
| NPI Enumeration Date: | 09/02/2010 |
| NPI Last Update Date: | 02/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 535 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |