Provider Demographics
NPI:1144208836
Name:PHILIP B. HALLORAN, MD
Entity Type:Organization
Organization Name:PHILIP B. HALLORAN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:HALLORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-823-6340
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 701
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-823-6340
Mailing Address - Fax:214-823-6344
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:SUITE 701
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-823-6340
Practice Address - Fax:214-823-6344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOOP112OtherBLUE CROSS ID #
TXOOP112OtherBLUE CROSS ID #