Provider Demographics
NPI:1629063094
Name:HALPERN, JEAN A (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:HALPERN
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 1:2301 HOUSE AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3176
Mailing Address - Country:US
Mailing Address - Phone:307-635-9131
Mailing Address - Fax:307-637-8300
Practice Address - Street 1:2301 HOUSE AVE
Practice Address - Street 2:STE 201
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3176
Practice Address - Country:US
Practice Address - Phone:307-635-9131
Practice Address - Fax:307-637-8300
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3374A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E14115Medicare UPIN
301821Medicare ID - Type Unspecified