Provider Demographics
NPI:1881638013
Name:HALTERMAN, ROBERT L (DO)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:HALTERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E. 104TH ST.
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-9712
Mailing Address - Country:US
Mailing Address - Phone:816-502-8752
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:1100 E POPLAR ST
Practice Address - Street 2:STE A
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4419
Practice Address - Country:US
Practice Address - Phone:479-754-5337
Practice Address - Fax:479-754-5348
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119015174400000X
KY02241207V00000X
NC200300349207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO119015OtherSTATE LICENSE
KY02241OtherSTATE LICENSE
SCN49003Medicaid
KY000000538418OtherANTHEM
MO119015OtherSTATE LICENSE
KY00401001Medicare PIN
KY000000538418OtherANTHEM
MOE41431Medicare UPIN