Provider Demographics
NPI:1013972884
Name:HALCUM, PHILLIP WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:WAYNE
Last Name:HALCUM
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 1:8625 COVE CIR
Mailing Address - Street 2:
Mailing Address - City:HACKETT
Mailing Address - State:AR
Mailing Address - Zip Code:72937-4161
Mailing Address - Country:US
Mailing Address - Phone:501-690-0298
Mailing Address - Fax:918-649-1199
Practice Address - Street 1:109 KERR AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5270
Practice Address - Country:US
Practice Address - Phone:918-649-1100
Practice Address - Fax:918-649-1199
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-7091171000000X
NM91-62171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider