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General NPI Number Information
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NPI Number | 1508973918
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Entity Type | Individual
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Provider Name | CHARLES S. HALBECK D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 10/23/2015
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Provider Practice Location Address
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Address Line | 915 E. 5TH ST.
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City | ALTON
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State | IL
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Zip | 62002-6471
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Country | US
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Telephone | 618-463-5300
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Fax | 618-463-5195
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Provider Business Mailing Address
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Address Line | 915 E. 5TH ST.
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City | ALTON
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State | IL
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Zip | 62002-6471
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Country | US
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Telephone | 618-463-5300
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Fax | 618-463-5195
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036061328
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | R2F64
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036.061328
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License Number State | IL
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