Provider Demographics
NPI:1144230988
Name:HALSTEAD, WILLIAM E (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:HALSTEAD
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:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1005
Mailing Address - Country:US
Mailing Address - Phone:541-963-6715
Mailing Address - Fax:541-962-7440
Practice Address - Street 1:1501 6TH ST STE C
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2419
Practice Address - Country:US
Practice Address - Phone:541-963-6715
Practice Address - Fax:541-962-7440
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD234242084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287204Medicaid
OR287204Medicaid
OR118116Medicare ID - Type Unspecified