Provider Demographics
NPI:1851493761
Name:STEPHEN J HALPERN & JACK WATSON MDS
Entity Type:Organization
Organization Name:STEPHEN J HALPERN & JACK WATSON MDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALPERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-425-0420
Mailing Address - Street 1:550A WATER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:831-425-0420
Mailing Address - Fax:831-425-0185
Practice Address - Street 1:550A WATER ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060
Practice Address - Country:US
Practice Address - Phone:831-425-0420
Practice Address - Fax:831-425-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22837207Q00000X
CAA65310207Q00000X
CA20A8853207Q00000X
CAA88228207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0100850Medicaid
CA020A88530Medicare PIN
CA00A653102Medicare PIN
CAZZZ02797ZMedicare ID - Type Unspecified
CA00A882280Medicare PIN
CA00A228371Medicare PIN