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Individual

JAMES MATTHEW HALVERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
11835 FISHING POINT DR, SUITE 104, NEWPORT NEWS, VA 23606-2584
(757) 599-5588
(757) 599-6893
Mailing address
11835 FISHING POINT DR, SUITE 104, NEWPORT NEWS, VA 23606-2584
(757) 599-5588
(757) 599-6893

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102049844
VA
207Q00000X
Family Medicine Physician
OS15143
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00Y043J02
MEDICARE PTAN
VA
05
1902899016
VA
01
C10736
GROUP PTN
Enumeration date
08/24/2005
Last updated
04/25/2019
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