Healthcare Provider Details

I. General information

NPI: 1447229802
Provider Name (Legal Business Name): ALTON VENSON HALLUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 W ORANGE GROVE RD BLDG 2
TUCSON AZ
85704
US

IV. Provider business mailing address

PO BOX 910221
DALLAS TX
75391-0221
US

V. Phone/Fax

Practice location:
  • Phone: 520-531-8967
  • Fax: 520-742-7180
Mailing address:
  • Phone: 520-519-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number21585
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: