Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | OS0005272 | FL |
NPI | 1083715171 |
---|---|
Provider Name | Dr. Edward William Halpren |
First Address | Fort Myers, FL 33912-4302 |
Second Address | Fort Myers, FL 33912-4302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 03/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
047104600 | (05) | FL |
80024 | BLUE CROSS BLUE SHIELD (01) | FL |
E31885 | (02) | FL |