Individual
FREDERICK R HALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
740 MCKINLEY AVE, KELLOGG, ID 83837-2523
(208) 783-1267
(208) 786-4471
Mailing address
740 MCKINLEY AVE, KELLOGG, ID 83837-2523
(208) 783-1267
(208) 786-4471
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M3559
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002790400
—
ID
01
—
080089993
RAILROAD MEDICARE
ID
01
—
1185830001
MEDICARE DMERC
ID
Enumeration date
05/16/2006
Last updated
08/19/2011
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