Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E2819 | CA |
NPI | 1023091808 |
---|---|
Provider Name | Dr. John Donald Halebian |
First Address | Burbank, CA 91506-1801 |
Second Address | Burbank, CA 91506-1801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2005 |
Last Update Date | 22/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E28190 | (05) | CA |
T19240 | (02) |