Active NPI
Larry Jene Hall, MD
- Pediatrics Physician
- Glide, OR
National Provider Identifier
1225207202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 6527
- Practice address
- 2010 Opportunity Lane
Glide, OR 97443-9779 - Phone
- (541) 496-4546
- Fax
- (541) 496-8538
- NPI assigned
- Feb 25, 2008
- Last updated
- Feb 25, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 6527 | OR | Primary |
Addresses
Primary practice location
2010 Opportunity Lane
Glide, OR 97443-9779
Mailing address
457 Lone Rock Rd
Glide, OR 97443-9779
Phone (541) 496-4546
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080796 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6527 | OR | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203897600000",
"number": "1225207202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "457 LONE ROCK RD",
"city": "GLIDE",
"state": "OR",
"postal_code": "974439779",
"telephone_number": "541-496-4546",
"fax_number": "541-496-4625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2010 OPPORTUNITY LANE",
"city": "GLIDE",
"state": "OR",
"postal_code": "974439779",
"telephone_number": "541-496-4546",
"fax_number": "541-496-8538"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALL",
"first_name": "LARRY",
"middle_name": "JENE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-25",
"last_updated": "2008-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OR",
"license": "6527",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "080796",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glide, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.