Provider Demographics
NPI:1821044587
Name:HALLORAN, JOHN IRELAND (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:IRELAND
Last Name:HALLORAN
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 1:1825 LOGAN AVE
Mailing Address - Street 2:RADIOLOGY DEPARTMENT
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1916
Mailing Address - Country:US
Mailing Address - Phone:319-235-3716
Mailing Address - Fax:
Practice Address - Street 1:1825 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1916
Practice Address - Country:US
Practice Address - Phone:319-235-3716
Practice Address - Fax:319-233-1630
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA289542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1158113Medicaid
IA24523OtherWELLMARK INS PLAN
IAI1583Medicare ID - Type Unspecified
IA24523OtherWELLMARK INS PLAN
IA24523OtherWELLMARK INS PLAN