Individual
DR. LARRY W. HALVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1423 N JEFFERSON AVE, #B100, SPRINGFIELD, MO 65802-1917
(417) 269-8825
(417) 269-8744
Mailing address
3800 S NATIONAL AVE, #540, SPRINGFIELD, MO 65807-5209
(417) 269-8825
(417) 269-8744
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R6217
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200212926
—
MO
01
—
22024
BCMO
MO
Enumeration date
10/12/2006
Last updated
01/07/2013
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