Individual
GLEN ALLEN HALVORSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4550 E BELL RD, SUITE 150, PHOENIX, AZ 85032-9306
(602) 795-3649
(602) 795-3996
Mailing address
4550 E BELL RD, SUITE 150, PHOENIX, AZ 85032-9306
(602) 795-3649
(602) 795-3996
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
13342
NV
208100000X
Physical Medicine & Rehabilitation Physician
Primary
13423
AZ
208100000X
Physical Medicine & Rehabilitation Physician
47769
CO
208100000X
Physical Medicine & Rehabilitation Physician
G75477
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
235780
AHCCCS
AZ
Enumeration date
10/15/2006
Last updated
02/17/2017
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