Healthcare Provider Details

I. General information

NPI: 1811917537
Provider Name (Legal Business Name): DONALD R HALSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 E GRAND AVE
ARROYO GRANDE CA
93420-2504
US

IV. Provider business mailing address

2050 S BLOSSER RD
SANTA MARIA CA
93458-7310
US

V. Phone/Fax

Practice location:
  • Phone: 805-270-1700
  • Fax: 805-481-7097
Mailing address:
  • Phone: 805-361-8028
  • Fax: 805-361-8097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG32152
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG32152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: