Individual
DR. LEWIS C HALVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12266 DE PAUL DR STE 315, BRIDGETON, MO 63044-2514
(314) 739-5858
Mailing address
220 COMPASS POINT DR, SAINT CHARLES, MO 63301-4405
(636) 947-4480
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
036078330
IL
2085R0202X
Diagnostic Radiology Physician
Primary
R1J93
MO
2085R0204X
Vascular & Interventional Radiology Physician
036078330
IL
2085R0204X
Vascular & Interventional Radiology Physician
R1J93
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036078330
—
IL
05
—
202775904
—
MO
01
—
300102486
RAILROAD MEDICARE NUMBER
—
01
—
300102491
RAILROAD MEDICARE NUMBER
—
Enumeration date
07/09/2006
Last updated
11/10/2020
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