Provider Demographics
NPI:1083684187
Name:HALFDANARSON, THORVARDUR R (MD)
Entity Type:Individual
Prefix:DR
First Name:THORVARDUR
Middle Name:R
Last Name:HALFDANARSON
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 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45995207R00000X, 207RX0202X, 207RH0003X
IA37199207R00000X, 207RH0003X
AZ46666207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN332174600Medicaid
AZ750631Medicaid
IA70098OtherWELLMARK BCBS
AZ763907Medicaid
IA70098OtherWELLMARK BCBS
AZ763907Medicaid
IAI20376Medicare PIN
IAP00426133Medicare PIN
AZ750631Medicaid
IA70098OtherWELLMARK BCBS