Individual
JEFFREY M. HALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
887 CONGRESS ST, SUITE 300, PORTLAND, ME 04102
(207) 662-5555
(207) 662-5526
Mailing address
301 US ROUTE 1, BUILDING C, SCARBOROUGH, ME 04074-9701
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
017790
ME
2086S0120X
Pediatric Surgery Physician
Primary
35-089504
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30207763
—
NH
05
—
432923399
—
ME
Enumeration date
05/22/2007
Last updated
03/10/2011
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