Provider Demographics
NPI:1790880698
Name:HALVORSON, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:HALVORSON
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 1:1228 FIRST STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8608
Mailing Address - Country:US
Mailing Address - Phone:205-621-8900
Mailing Address - Fax:205-621-7169
Practice Address - Street 1:1228 FIRST STREET NORTH
Practice Address - Street 2:SUITE 301
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8608
Practice Address - Country:US
Practice Address - Phone:205-621-8900
Practice Address - Fax:205-621-7169
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20146174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2512856002OtherCIGNA
AL51025753OtherBCBS OF AL
AL631215960OtherVIVA
AL51530334OtherBCBS OF AL
ALF51696OtherHEALTHSPRINGS OF ALABAMA
AL1010027OtherUNITED HEALTHCARE
AL529902750Medicaid
AL51008484OtherBCBS OF AL
ALF51696Medicare UPIN
AL000008484Medicare ID - Type UnspecifiedALABASTER OFFICE
AL529902750Medicaid