Provider Demographics
NPI:1992782924
Name:HALBROOK, JOHN C (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:HALBROOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3103
Mailing Address - Country:US
Mailing Address - Phone:601-482-1555
Mailing Address - Fax:601-696-4608
Practice Address - Street 1:1704 23RD AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3103
Practice Address - Country:US
Practice Address - Phone:601-482-1555
Practice Address - Fax:601-696-4608
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07013174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000121501Medicaid
MS900004196OtherPALMETTO GBA RAILROAD
MSCF9149OtherRAILROAD GROUP #
MS830000087OtherMEDICARE LEGACY
MS1164433678OtherCLINIC NPI
MS00121501Medicaid