Provider Demographics
NPI:1174651608
Name:HALL, THOMAS KENT (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:KENT
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18701 SE CROSSWINDS LN
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-1916
Mailing Address - Country:US
Mailing Address - Phone:865-617-7551
Mailing Address - Fax:
Practice Address - Street 1:951 NW 13TH ST STE 1C
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2337
Practice Address - Country:US
Practice Address - Phone:561-447-9341
Practice Address - Fax:561-447-9352
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000090402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621244650OtherCHAMPUS
TN3386048Medicaid
TN2001147OtherBLUE CROSS TENNESSEE
TN164066OtherBLACK LUNG
TN62124465001OtherJOHN DEERE
KY64772874Medicaid
TNB04497Medicare UPIN
TN3386048Medicare ID - Type Unspecified