Healthcare Provider Details

I. General information

NPI: 1801908405
Provider Name (Legal Business Name): WILLIAM G HALVERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 N. MAPLE AVENUE
NEW HAMPTON IA
50659-1154
US

IV. Provider business mailing address

621 S ILLINOIS AVE SUITE 103
MASON CITY IA
50401-5489
US

V. Phone/Fax

Practice location:
  • Phone: 641-394-2151
  • Fax: 641-394-3150
Mailing address:
  • Phone: 641-494-3041
  • Fax: 641-494-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22613
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: