Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G65796 | CA |
NPI | 1235211145 |
---|---|
Provider Name | Jeffrey L Halbrecht |
First Address | San Francisco, CA 94139-3373 |
Second Address | San Francisco, CA 94115-2373 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 04/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G657960 | (05) | CA |
00G657960 | BLUE CROSS, BLUE SHIELD (01) | CA |
197167000 | US DEPT OF LABOR (01) | |
E97971 | (02) | CA |