Halverson, Mark Rollo

Halverson, Mark Rollo is an individual health care provider with primary practice located at 816 W Cannon St , Fort Worth TX 76104-3146. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Radiology, which is considered as his primary health care specialty. Halverson, Mark Rollo can be contacted via phone (817) 321-0387.

Contact Information

Primary practice address
816 W Cannon St Fort Worth TX 76104-3146
Phone: (817) 321-0387
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Radiology 2085P0229X MD445798 Pennsylvania
Allopathic & Osteopathic Physicians / Pediatric Radiology 2085P0229X P8785 Texas

Profile Details

NPI number 1619175890
LBN Legal business name Halverson, Mark Rollo
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 10th, 2007
Last updated Sep 19th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619175890 NPPES
Texas MEDICAID 285250104
Texas MEDICAID 121715004
Texas MEDICAID 121715008

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