Provider Demographics
NPI:1568474377
Name:HALVORSEN, PHILIP ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ROY
Last Name:HALVORSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:560 GAGE BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3525
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:969 STEVENS DR
Practice Address - Street 2:SUITE 3A
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3525
Practice Address - Country:US
Practice Address - Phone:509-946-8696
Practice Address - Fax:509-946-8646
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025724207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1013452Medicaid
WA1568474377OtherNPI
WA1120732Medicaid
WA1568474377OtherNPI
WA1013452Medicaid