Individual
JACK LEROY HALING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
824 PINE ST, MOUNT SHASTA, CA 96067-2137
(530) 926-4528
(530) 926-5070
Mailing address
PO BOX 339, MOUNT SHASTA, CA 96067-0339
(530) 926-5613
(530) 926-8798
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
C28244
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C282440
—
CA
Enumeration date
10/27/2005
Last updated
03/21/2012
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