Provider Demographics
NPI:1508028895
Name:HALOL, ATHENA JANE OCAMPO (MD)
Entity Type:Individual
Prefix:DR
First Name:ATHENA JANE
Middle Name:OCAMPO
Last Name:HALOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUT BANK
Mailing Address - State:MT
Mailing Address - Zip Code:59427-3015
Mailing Address - Country:US
Mailing Address - Phone:406-873-5670
Mailing Address - Fax:406-873-5675
Practice Address - Street 1:519 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUT BANK
Practice Address - State:MT
Practice Address - Zip Code:59427-3015
Practice Address - Country:US
Practice Address - Phone:406-873-5670
Practice Address - Fax:406-873-5675
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT12475OtherSTATE LICENSE