Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2003004986 | MO |
N | 207Q00000X | Family Doctor | 2003004986 | MO |
NPI | 1518954197 |
---|---|
Provider Name | Dr. Kelly D Halma |
First Address | Kirksville, MO 63501-1443 |
Second Address | Kirksville, MO 63501-1443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 04/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207404609 | (05) | MO |
I37120 | (02) | |
P00248163 | RAILROAD MEDICARE (01) |