Provider Demographics
NPI:1831152008
Name:HALVORSON, PETER JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JAMES
Last Name:HALVORSON
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 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:6341 UNIVERSITY AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-4946
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-586-5888
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47931208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP53178OtherHEALTHPARTNERS
MN125173200Medicaid
MN2365755OtherAMERICA'S PPO
MN1701444OtherMEDICA
MN1044101OtherPREFERRED ONE
MN488K8HAOtherBCBS OF MN
MN7533292OtherAETNA
MN132905OtherUCARE MN
MNF96506Medicare UPIN
MN132905OtherUCARE MN