Organization
GLEN HALVORSON MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLEN A HALVORSON MD (OWNER)
(602) 795-3649
Entity
Organization
Contact information
Practice address
4550 E BELL RD, STE 150, PHOENIX, AZ 85032-9306
(602) 795-3649
(602) 795-3996
Mailing address
4550 E BELL RD, STE 150, PHOENIX, AZ 85032-9306
(602) 795-3674
(602) 795-3996
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
13423
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13423
STATE LICENSE
AZ
05
—
235780
—
AZ
Enumeration date
04/04/2016
Last updated
02/17/2017
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