Provider Demographics
NPI:1740286970
Name:HALVERSEN, GARY L (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:HALVERSEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1151 E 3900 S
Mailing Address - Street 2:#B150
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1216
Mailing Address - Country:US
Mailing Address - Phone:801-262-3441
Mailing Address - Fax:801-269-9005
Practice Address - Street 1:1151 E 3900 S
Practice Address - Street 2:#B150
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1216
Practice Address - Country:US
Practice Address - Phone:801-262-3441
Practice Address - Fax:801-269-9005
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-09-30
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Provider Licenses
StateLicense IDTaxonomies
UT16198612052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology