Provider Demographics
NPI:1750332011
Name:HALLIGAN, WILLIAM KEITH (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KEITH
Last Name:HALLIGAN
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 1:2512 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3399
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 NW MYHRE RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7681
Practice Address - Country:US
Practice Address - Phone:360-830-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025913208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA75432OtherLABOR & INDUSTRIES
WA8933538OtherCRIME VICTIMS COMP
5858030OtherAETNA
HA1812OtherREGENCE BLUE SHIELD
020004214OtherRAILROAD MEDICARE
WA8177800Medicaid
WA8177800Medicaid
WAG000250413Medicare PIN
WAG000250611Medicare PIN
WAG8900265Medicare UPIN
G8886852Medicare PIN
WAG8852198Medicare PIN
WAG115136418Medicare PIN
AH7662489OtherDEA
WA75432OtherLABOR & INDUSTRIES
HA1812OtherREGENCE BLUE SHIELD
WAGAB05052Medicare PIN
WAGAB05050Medicare PIN