Individual
JERRY LEE HALVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
34700 VALLEY RD, OCONOMOWOC, WI 53066-4500
(262) 646-4411
(262) 646-1076
Mailing address
34700 VALLEY RD, OCONOMOWOC, WI 53066-4500
(262) 646-4411
(262) 646-1076
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
43851
WI
2084P0015X
Psychosomatic Medicine Physician
43851
WI
2084P0800X
Psychiatry Physician
Primary
43851
WI
Other
Enumeration date
03/22/2006
Last updated
05/04/2021
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