Basic Information
| Provider Information | |||||||||
| NPI: | 1245899582 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | JORDAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7259 S BINGHAM JUNCTION BLVD | ||||||||
| Address2: | |||||||||
| City: | MIDVALE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840474860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019303000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7259 S BINGHAM JUNCTION BLVD | ||||||||
| Address2: | |||||||||
| City: | MIDVALE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840474860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019303000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2019 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 125074131 | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.