Provider Demographics
NPI:1154506426
Name:HALVORSEN, ROBERT B (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:HALVORSEN
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 1:2033 MAIN ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6056
Mailing Address - Country:US
Mailing Address - Phone:941-951-1960
Mailing Address - Fax:
Practice Address - Street 1:2033 MAIN ST
Practice Address - Street 2:SUITE 406
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6056
Practice Address - Country:US
Practice Address - Phone:941-951-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL53319208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB61161Medicare UPIN