Provider Demographics
NPI:1710973029
Name:HALLGREN, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:HALLGREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 31237
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-0237
Mailing Address - Country:US
Mailing Address - Phone:402-509-8964
Mailing Address - Fax:402-262-1503
Practice Address - Street 1:10040 REGENCY CIR STE 375
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3755
Practice Address - Country:US
Practice Address - Phone:402-509-8964
Practice Address - Fax:402-262-1503
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0058826207Q00000X
NE25348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine