Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 1707 | NC |
Y | 111NN0400X | Neurology | DC19816 | CA |
NPI | 1396777579 |
---|---|
Provider Name | James Gregory Halvorson |
First Address | San Marcos, CA 92069-2973 |
Second Address | San Marcos, CA 92069-2973 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 03/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
890843M | (05) | NC |
U36018 | (02) | NC |