Provider Demographics
NPI:1902169485
Name:HALVERSEN, ZACHARY PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:PAUL
Last Name:HALVERSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 N 3RD AVENUE
Mailing Address - Street 2:#101
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864
Mailing Address - Country:US
Mailing Address - Phone:208-263-1435
Mailing Address - Fax:208-263-4580
Practice Address - Street 1:606 N 3RD AVENUE
Practice Address - Street 2:#101
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864
Practice Address - Country:US
Practice Address - Phone:208-263-1435
Practice Address - Fax:208-263-4580
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM13002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine