Healthcare Provider Details

I. General information

NPI: 1487640397
Provider Name (Legal Business Name): ANDREW C HALPERN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOOTH RD SUITE A
ORMOND BEACH FL
32174-5715
US

IV. Provider business mailing address

PO BOX 732901
DALLAS TX
75373-2901
US

V. Phone/Fax

Practice location:
  • Phone: 386-523-1212
  • Fax: 386-523-1213
Mailing address:
  • Phone: 386-226-4590
  • Fax: 386-226-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME124133
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number223250-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: