Healthcare Provider Details

I. General information

NPI: 1962516500
Provider Name (Legal Business Name): ROBERT EDWARD HALLIGAN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

230 E LOUIS WAY
TEMPE AZ
85284-1478
US

V. Phone/Fax

Practice location:
  • Phone: 602-200-2323
  • Fax:
Mailing address:
  • Phone: 480-831-2624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberAZ20797
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberAZ20797
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: