Individual
DR. CHARLES RAY HALLIBURTON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5228 DIJON DR, BATON ROUGE, LA 70808-4311
(225) 765-8829
(225) 765-8283
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 765-8829
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
10938R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110110126
RAILROAD MEDICARE
LA
05
—
1656500
—
LA
Enumeration date
07/22/2005
Last updated
12/15/2025
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