Provider Demographics
NPI:1134357692
Name:HALLIDAY, JOSEPH BENJAMIN (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BENJAMIN
Last Name:HALLIDAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-0262
Mailing Address - Country:US
Mailing Address - Phone:864-512-3879
Mailing Address - Fax:864-512-2083
Practice Address - Street 1:703 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-512-3915
Practice Address - Fax:864-512-3920
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36752207RI0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC367524Medicaid
SC367524Medicaid