Provider Demographics
NPI:1811917537
Name:HALSEY, DONALD R
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:HALSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8028
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:1057 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2504
Practice Address - Country:US
Practice Address - Phone:805-270-1700
Practice Address - Fax:805-481-7097
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32152207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1508OtherMEDICARE GROUP ID
CAW1508AOtherPTAN: B1509Y PTAN GROUP
CAFHC70693FMedicaid
CAW1508COtherPTAN: B1509Z. GROUP
CAW1508DOtherPTAN: B1509X PTAN GROUP
CAW1508EOtherPTAN: B1509W , PTAN GROUP
CAW1508COtherPTAN: B1509Z
CAW1508EOtherPTAN: B1509W PTAN GROUP
CAW1508AOtherMEDICARE GROUP ID
CAA45032Medicare UPIN
CAFHC70693FMedicaid
CAWG32152BMedicare PIN