Individual
WILLIAM DYRK HALSTEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1801 N JACKSON ST, TULLAHOMA, TN 37388-2201
(931) 393-3000
Mailing address
PO BOX 634706, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
14889
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3002115
—
TN
01
—
4039161
BLUE CROSS
TN
01
—
P00254188
MEDICARE RAILROAD
TN
Enumeration date
05/25/2006
Last updated
11/07/2007
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