Individual
DR. GARY HALVORSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1255 HILYARD ST, EUGENE, OR 97401-3718
(503) 686-7300
Mailing address
PO BOX 4078, PORTLAND, OR 97208-4078
(888) 633-0086
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD15445
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195404
—
OR
01
—
76328
WASHINGTON L&I
—
05
—
8280042
—
WA
01
—
A015
CHAMPUS
—
01
—
C92795
PROVIDENCE
—
01
—
J0475-06
PACIFIC SOURCE
—
05
—
XPY185060
—
CA
Enumeration date
06/06/2006
Last updated
12/03/2007
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