Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | R9D75 | MO |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | R9D75 | MO |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | R9D75 | MO |
NPI | 1245232693 |
---|---|
Provider Name | Randall E Halley |
First Address | Nixa, MO 65714-9406 |
Second Address | Columbia, MO 65203-2582 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 28/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080184553 | RAILROAD MEDICARE (01) | MO |
1245232693 | (05) | MO |
241991223 | (05) | MO |
241991231 | (05) | MO |
CJ9303 | RR MEDICARE - PRIVATE (01) | MO |
D41510 | (02) | |
P00221221 | RR MEDICARE DHOS (01) |