Basic Information
| Provider Information | |||||||||
| NPI: | 1730158940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALPERIN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 41543 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322031543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043764048 | ||||||||
| FaxNumber: | 9042258477 | ||||||||
| Practice Location | |||||||||
| Address1: | 463820 SR 200 | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | YULEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042252770 | ||||||||
| FaxNumber: | 9042258477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 11/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME62735 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 251484200 | 05 | FL | MEDICAID |