Provider Demographics
NPI:1235211145
Name:HALBRECHT, JEFFREY L (MD, PC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:HALBRECHT
Suffix:
Gender:M
Credentials:MD, PC
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 39000
Mailing Address - Street 2:DEPT# 33373
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-3373
Mailing Address - Country:US
Mailing Address - Phone:415-923-0944
Mailing Address - Fax:415-923-5896
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:SUITE 331
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:415-923-0944
Practice Address - Fax:415-923-5896
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65796173000000X, 174400000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No173000000XOther Service ProvidersLegal Medicine
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G657960OtherBLUE CROSS, BLUE SHIELD
CA00G657960Medicaid
197167000OtherUS DEPT OF LABOR
197167000OtherUS DEPT OF LABOR
CA00G657960OtherBLUE CROSS, BLUE SHIELD