Healthcare Provider Details

I. General information

NPI: 1396740338
Provider Name (Legal Business Name): PETER SPELMAN HALT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date: 03/18/2006
Reactivation Date: 04/04/2006

III. Provider practice location address

914 PINE ST
MOUNT SHASTA CA
96067-2143
US

IV. Provider business mailing address

PO BOX 1086
YREKA CA
96097-1086
US

V. Phone/Fax

Practice location:
  • Phone: 530-926-9329
  • Fax: 530-926-9855
Mailing address:
  • Phone: 530-842-7297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA76207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: