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General NPI Number Information
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NPI Number | 1275066615
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Entity Type | Organization
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Legal Business Name | HALLETT HEART PA
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 1113 ELLIS AVE
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City | LUFKIN
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State | TX
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Zip | 75904-3346
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Country | US
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Telephone | 936-631-3480
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Fax |
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Provider Business Mailing Address
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Address Line | 1113 ELLIS AVE
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City | LUFKIN
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State | TX
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Zip | 75904-3346
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT HALLETT
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Credential | M.D.
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Telephone | 936-631-3480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | L9581
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License Number State | TX
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