Healthcare Provider Details

I. General information

NPI: 1417061482
Provider Name (Legal Business Name): CHRISTOPHER SEAN HALING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 EAST BROADWAY ST JOHNS MEDICAL CENTER DEPT OF RADIOLOGY
JACKSON WY
83001
US

IV. Provider business mailing address

PO BOX 9230
JACKSON WY
83002-9230
US

V. Phone/Fax

Practice location:
  • Phone: 800-633-1905
  • Fax:
Mailing address:
  • Phone: 800-633-1905
  • Fax: 913-491-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number6408A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD216371
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: