Provider Demographics
NPI:1063737021
Name:HALIBURTON, JAMES RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:HALIBURTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 E SAN ANTONIO ST
Mailing Address - Street 2:403 WEST
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6004
Mailing Address - Country:US
Mailing Address - Phone:361-582-4187
Mailing Address - Fax:361-582-4172
Practice Address - Street 1:601 E SAN ANTONIO ST
Practice Address - Street 2:403 WEST
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6004
Practice Address - Country:US
Practice Address - Phone:361-582-4187
Practice Address - Fax:361-582-4172
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ38842084P0800X
KY461872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX428556YSFSMedicare PIN