Provider Demographics
NPI:1730183005
Name:HALVEY, CORNELIUS H (MD)
Entity type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:H
Last Name:HALVEY
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 1:2121 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3804
Mailing Address - Country:US
Mailing Address - Phone:941-955-6363
Mailing Address - Fax:941-556-3768
Practice Address - Street 1:2121 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3804
Practice Address - Country:US
Practice Address - Phone:941-955-6363
Practice Address - Fax:941-556-3768
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044167207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL180011575OtherRAILROAD MEDICARE
FL180011575OtherRAILROAD MEDICARE
FLD70640Medicare UPIN