Healthcare Provider Details

I. General information

NPI: 1154764116
Provider Name (Legal Business Name): SCHUYLER JOSEF HALVERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 3005B
SAINT LOUIS MO
63141-8266
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 3005B
SAINT LOUIS MO
63141-8266
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-5850
  • Fax: 314-567-9169
Mailing address:
  • Phone: 314-567-5850
  • Fax: 314-567-9169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number2018013809
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: