Basic Information
| Provider Information | |||||||||
| NPI: | 1508806332 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAMES R. HALDERMAN MD AMC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7156 | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952670156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094676866 | ||||||||
| FaxNumber: | 2094676865 | ||||||||
| Practice Location | |||||||||
| Address1: | 1420 N TRACY BLVD | ||||||||
| Address2: | |||||||||
| City: | TRACY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953763451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098351500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 08/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | HALDERMAN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2098351500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A68157 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00A681570 | 05 | CA | MEDICAID |