Healthcare Provider Details

I. General information

NPI: 1194852855
Provider Name (Legal Business Name): ALLAN D. HALBERT, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4071 TATES CREEK CENTRE DR SUITE 100
LEXINGTON KY
40517-3062
US

IV. Provider business mailing address

4071 TATES CREEK CENTRE DR SUITE 100
LEXINGTON KY
40517-3062
US

V. Phone/Fax

Practice location:
  • Phone: 858-273-3888
  • Fax: 859-977-0170
Mailing address:
  • Phone: 858-273-3888
  • Fax: 859-977-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20775
License Number StateKY

VIII. Authorized Official

Name: ALLAN DUANE HALBERT
Title or Position: OWNER
Credential: MD
Phone: 859-273-3888