Basic Information
| Provider Information | |||||||||
| NPI: | 1760825822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALLECK | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | LEONARD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27128 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841270128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015074384 | ||||||||
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| Practice Location | |||||||||
| Address1: | 310 SUNNYVIEW LN | ||||||||
| Address2: | |||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599013129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067515310 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2013 | ||||||||
| LastUpdateDate: | 03/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 9149500-1205 | UT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 80245 | MT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 80245 | MT | N | Allopathic & Osteopathic Physicians | Hospitalist | 390200000X | OR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208M00000X | 9149500-1205 | UT | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.