=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831542257
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | F. JOSEPH HALCOMB III M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2016
-----------------------------------------------------
Last Update Date | 07/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2466 AVENIDA DE LA ROSA
-----------------------------------------------------
City | CAMARILLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93012-9090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-987-0158
-----------------------------------------------------
Fax | 805-445-8727
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2466 AVENIDA DE LA ROSA
-----------------------------------------------------
City | CAMARILLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93012-9090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-987-0158
-----------------------------------------------------
Fax | 805-445-8727
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | G69470
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------