Provider Demographics
NPI:1659907681
Name:HALBROOK, JAAN PAUL
Entity Type:Individual
Prefix:
First Name:JAAN
Middle Name:PAUL
Last Name:HALBROOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MARBELLA CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-3903
Mailing Address - Country:US
Mailing Address - Phone:864-404-6346
Mailing Address - Fax:
Practice Address - Street 1:123 MARBELLA CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-3903
Practice Address - Country:US
Practice Address - Phone:864-404-6346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-22
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC028691146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic