Hall-Davis, Jacquelyn

Hall-Davis, Jacquelyn is an individual health care provider with primary practice located at 12 N 64Th St , Belleville IL 62223-3809. She recently has only one registered license in Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry, which is considered as her primary health care specialty. Hall-Davis, Jacquelyn can be contacted via phone (618) 397-0900.

Contact Information

Primary practice address
12 N 64Th St Belleville IL 62223-3809
Phone: (618) 397-0900
Fax: (618) 397-0093
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry 2084P0804X 036080270 Illinois

Profile Details

NPI number 1619042124
LBN Legal business name Hall-Davis, Jacquelyn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 21st, 2006
Last updated Aug 10th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619042124 NPPES
Missouri Other 3649 BCBS MO
Missouri MEDICAID 036080270 BCBS MO

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