MEDICARE: JEFFREY BURKE HALLDORSON M.D.

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	207RN0300X	Nephrology Physician	G86089	CA
2	208600000X	Surgery Physician	G86089	CA
3	204F00000X	Transplant Surgery Physician	G86089	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G86089	OTHER	CA	CA LICENSE

General Provider Information

NPI Number	:	1558446351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY BURKE HALLDORSON M.D.

Provider Business Mailing Address
First Line	:	9373 HAZARD WAY STE 200
Second Line	:	STE 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1226
Country	:	US
Telephone Number	:	858-810-0000
Fax Number	:	858-268-1911

Provider Business Practice Location Address
First Line	:	8010 FROST ST STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4222
Country	:	US
Telephone Number	:	858-637-4700
Fax Number	:	858-637-4701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	01/16/2026

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Directions to “ JEFFREY BURKE HALLDORSON M.D.” Practice Location

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