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General NPI Number Information
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NPI Number | 1972766483
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Entity Type | Individual
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Provider Name | ANDY HALBERG DO
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Gender | Male
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 1300 N 12TH ST SUITE 605
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City | PHOENIX
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State | AZ
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Zip | 85006-2848
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Country | US
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Telephone | 602-239-4567
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Fax |
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Provider Business Mailing Address
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Address Line | 262 LEROY GEORGE DR
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City | CLYDE
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State | NC
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Zip | 28721-7430
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Country | US
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Telephone | 828-631-9462
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Fax |
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 2011-00938
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2011-00938
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License Number State | NC
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