Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | LP0803 | KS |
Y | 103TC0700X | Clinical Psychologist | LP0803 | KS |
NPI | 1003822982 |
---|---|
Provider Name | Mr. Brent Leon Halderman |
First Address | Olathe, KS 66062 |
Second Address | Olathe, KS 66062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 01/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100241380A | (05) | KS |
19387049 | BCBS OF KC (01) | MO |
680005403 | RAILROAD MEDICARE (01) | KS |
701013 | BCBS OF KANSAS (01) | KS |
R91643 | (02) |