Provider Demographics
NPI:1427018621
Name:HALANYCH, JEWELL H (MD)
Entity type:Individual
Prefix:
First Name:JEWELL
Middle Name:H
Last Name:HALANYCH
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 1:2055 E SOUTH BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2001
Mailing Address - Country:US
Mailing Address - Phone:334-284-5211
Mailing Address - Fax:334-284-9020
Practice Address - Street 1:2055 E SOUTH BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2002
Practice Address - Country:US
Practice Address - Phone:334-284-5211
Practice Address - Fax:334-284-9020
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051517650Medicaid
AL051517650OtherBCBS
636005396005OtherHUMANA GOLD CHOICE MEDICARE
ALH97013Medicare UPIN
P00086955Medicare PIN
AL051517650Medicare PIN