Healthcare Provider Details

I. General information

NPI: 1487396685
Provider Name (Legal Business Name): ERIC MICHAEL HALPERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 10/31/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

H M SMITH BLVVD
CAMP LEJUNE NC
28547
US

IV. Provider business mailing address

PSC BOX 20180
CAMP LEJUNE NC
28542-0180
US

V. Phone/Fax

Practice location:
  • Phone: 804-926-0964
  • Fax:
Mailing address:
  • Phone: 804-926-0964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: