Healthcare Provider Details

I. General information

NPI: 1902899016
Provider Name (Legal Business Name): JAMES MATTHEW HALVERSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: J MATTHEW HALVERSON DO

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date: 03/27/2006
Reactivation Date: 04/13/2006

III. Provider practice location address

11835 FISHING POINT DR SUITE 104
NEWPORT NEWS VA
23606-2584
US

IV. Provider business mailing address

11835 FISHING POINT DR SUITE 104
NEWPORT NEWS VA
23606-2584
US

V. Phone/Fax

Practice location:
  • Phone: 757-599-5588
  • Fax: 757-599-6893
Mailing address:
  • Phone: 757-599-5588
  • Fax: 757-599-6893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS15143
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102049844
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: