Provider Demographics
NPI:1558383893
Name:HALSELL, JEFFREY STEPHEN (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:STEPHEN
Last Name:HALSELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5995 S POINTE BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3273
Mailing Address - Country:US
Mailing Address - Phone:239-362-2545
Mailing Address - Fax:239-362-0544
Practice Address - Street 1:5995 S POINTE BLVD STE 109
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3273
Practice Address - Country:US
Practice Address - Phone:239-362-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3729208100000X
FLOS17915208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100103150AMedicaid
FLPN115OtherMEDICARE