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General NPI Number Information
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NPI Number | 1831249481
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Entity Type | Individual
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Provider Name | TIMOTHY J HALLORAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 500 N MAIN ST SUITE 101
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City | LE SUEUR
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State | MN
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Zip | 56058-5500
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Country | US
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Telephone | 507-665-4017
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Fax | 507-665-4019
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Provider Business Mailing Address
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Address Line | 700 W PRAIRIE ST
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City | BELLE PLAINE
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State | MN
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Zip | 56011-1000
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Country | US
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Telephone | 952-873-2276
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Fax | 952-873-4222
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 273301
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License Number State | MN
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