Provider Demographics
NPI:1083621957
Name:HALAMANDARIS, GUS GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GUS
Middle Name:GEORGE
Last Name:HALAMANDARIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SAN JOSE ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3901
Mailing Address - Country:US
Mailing Address - Phone:831-424-0807
Mailing Address - Fax:831-424-3408
Practice Address - Street 1:220 SAN JOSE ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3901
Practice Address - Country:US
Practice Address - Phone:831-424-0807
Practice Address - Fax:831-424-3408
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57889207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
94170316793901A005OtherTRICARE
CAZZZ70373ZMedicaid
94170316793901A005OtherTRICARE
CAZZZ70373ZMedicaid