Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A 10182 | CA |
NPI | 1003095696 |
---|---|
Provider Name | Dr. Timothy Lon Halpin |
First Address | Beale Afb, CA 95903-1905 |
Second Address | Beale Afb, CA 95903-1905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2007 |
Last Update Date | 20/12/2021 |