Healthcare Provider Details

I. General information

NPI: 1881638013
Provider Name (Legal Business Name): ROBERT L HALTERMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E POPLAR ST STE A
CLARKSVILLE AR
72830-4419
US

IV. Provider business mailing address

901 E. 104TH ST. MAILSTOP 400N
KANSAS CITY MO
64131-9712
US

V. Phone/Fax

Practice location:
  • Phone: 479-754-5337
  • Fax: 479-754-5348
Mailing address:
  • Phone: 816-502-8752
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number119015
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number02241
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number119015
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number200300349
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: