Provider Demographics
NPI:1073187498
Name:HALLORAN, BENJAMIN TRAVIS (DO)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:TRAVIS
Last Name:HALLORAN
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:PETERSON REGIONAL MEDICAL CENTER
Mailing Address - Street 2:551 HILL COUNTRY DRIVE
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PETERSON REGIONAL MEDICAL CENTER
Practice Address - Street 2:551 HILL COUNTRY DRIVE
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028
Practice Address - Country:US
Practice Address - Phone:830-896-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7690207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine