Provider Demographics
NPI:1497744700
Name:HALBUR, THERESE G (MD)
Entity type:Individual
Prefix:DR
First Name:THERESE
Middle Name:G
Last Name:HALBUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:THERESE
Other - Middle Name:
Other - Last Name:GRETEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3211 KINGMAN RD
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-3940
Mailing Address - Country:US
Mailing Address - Phone:515-292-3502
Mailing Address - Fax:
Practice Address - Street 1:3211 KINGMAN RD
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-3940
Practice Address - Country:US
Practice Address - Phone:515-292-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27620208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0065540Medicaid
IA0065540Medicaid
IAE67882Medicare UPIN