1124601257 NPI number — ALICIA DEANNE HALBERT DO

Table of content: ALICIA DEANNE HALBERT DO (NPI 1124601257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124601257 NPI number — ALICIA DEANNE HALBERT DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALBERT
Provider First Name:
ALICIA
Provider Middle Name:
DEANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRAFF
Provider Other First Name:
ALICIA
Provider Other Middle Name:
DEANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124601257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 E AJO WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85713-6204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-874-7520
Provider Business Mailing Address Fax Number:
520-874-7539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 E AJO WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85713-6204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-874-7520
Provider Business Practice Location Address Fax Number:
520-874-7539
Provider Enumeration Date:
05/05/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  R3565 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)