Healthcare Provider Details

I. General information

NPI: 1558446351
Provider Name (Legal Business Name): JEFFREY BURKE HALLDORSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 FROST ST STE 100
SAN DIEGO CA
92123-4222
US

IV. Provider business mailing address

9373 HAZARD WAY STE 200 STE 200
SAN DIEGO CA
92123-1226
US

V. Phone/Fax

Practice location:
  • Phone: 858-637-4700
  • Fax: 858-637-4701
Mailing address:
  • Phone: 858-810-0000
  • Fax: 858-268-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberG86089
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG86089
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG86089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: