Provider Demographics
NPI:1275683823
Name:HALLETT, JEFFREY STEWART (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:STEWART
Last Name:HALLETT
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 1:16000 PARK VALLEY DRIVE
Mailing Address - Street 2:SUITE #130
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4009
Mailing Address - Country:US
Mailing Address - Phone:512-244-3422
Mailing Address - Fax:512-255-6829
Practice Address - Street 1:16000 PARK VALLEY DRIVE
Practice Address - Street 2:SUITE #130
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4009
Practice Address - Country:US
Practice Address - Phone:512-244-3422
Practice Address - Fax:512-255-6829
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1588207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00DU91OtherBLUE CROSS BLUE SHIELD
00DU91Medicare ID - Type Unspecified
TX00DU91OtherBLUE CROSS BLUE SHIELD