MEDICARE: PHILIP B. HALLORAN, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OOP112	OTHER	TX	BLUE CROSS ID #

General Provider Information

NPI Number	:	1144208836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILIP B. HALLORAN, MD

Provider Business Mailing Address
First Line	:	3600 GASTON AVE
Second Line	:	SUITE 701
City	:	DALLAS
State	:	TX
Zip	:	75246-1800
Country	:	US
Telephone Number	:	214-823-6340
Fax Number	:	214-823-6344

Provider Business Practice Location Address
First Line	:	3600 GASTON AVE
Second Line	:	SUITE 701
City	:	DALLAS
State	:	TX
Zip	:	75246-1800
Country	:	US
Telephone Number	:	214-823-6340
Fax Number	:	214-823-6344

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. PHILIP BRADLEY HALLORAN
Credential	:	MD
Telephone Number	:	214-823-6340

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	08/22/2020

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