Provider Demographics
NPI:1386739266
Name:HALDERMAN, LINDA (MD)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:HALDERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 ROSE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-3251
Mailing Address - Country:US
Mailing Address - Phone:559-896-0006
Mailing Address - Fax:
Practice Address - Street 1:1142 ROSE AVE STE C
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3251
Practice Address - Country:US
Practice Address - Phone:559-896-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A715870208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH70101Medicare UPIN
CA00A715870Medicare ID - Type Unspecified