Provider Demographics
NPI:1639289978
Name:HALPHEN, JOHN MICHAEL SR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:HALPHEN
Suffix:SR
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 1:523 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2624
Mailing Address - Country:US
Mailing Address - Phone:713-802-1048
Mailing Address - Fax:713-869-1389
Practice Address - Street 1:5656 KELLEY ST STE 4
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-1967
Practice Address - Country:US
Practice Address - Phone:281-952-1327
Practice Address - Fax:713-566-4474
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3583207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096577403Medicaid
8W6316OtherBCBSTX
8W6316OtherBCBSTX
TX8K4945Medicare PIN