Mark Rollo Halverson, MD | |
816 W Cannon St, Fort Worth, TX 76104-3146 | |
(817) 321-0387 | |
Not Available |
Full Name | Mark Rollo Halverson |
---|---|
Gender | Male |
Speciality | Radiology - Pediatric Radiology |
Location | 816 W Cannon St, Fort Worth, Texas |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1619175890 | NPI | - | NPPES |
285250104 | Medicaid | TX | |
121715004 | Medicaid | TX | |
121715008 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2085P0229X | Radiology - Pediatric Radiology | MD445798 (Pennsylvania) | Secondary |
2085P0229X | Radiology - Pediatric Radiology | P8785 (Texas) | Primary |
Entity Name | Children's Radiological Institute, Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1508895608 PECOS PAC ID: 8921068149 Enrollment ID: O20041012001630 |
Mailing Address | Practice Location Address |
---|---|
Mark Rollo Halverson, MD 816 W Cannon St, Fort Worth, TX 76104-3146 Ph: (817) 321-0387 | Mark Rollo Halverson, MD 816 W Cannon St, Fort Worth, TX 76104-3146 Ph: (817) 321-0387 |
Kelly C Starkey, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 815 Pennsylvania Ave, Fort Worth, TX 76104 Phone: 817-321-0404 Fax: 469-522-6889 | |
Dr. Mark Sohner, M.D. Radiology Medicare: Medicare Enrolled Practice Location: 815 Pennsylvania Ave, Fort Worth, TX 76104 Phone: 173-210-4048 | |
Dr. John A Queralt, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 815 Pennsylvania Ave, Fort Worth, TX 76104 Phone: 817-321-0312 Fax: 817-317-7033 | |
Dr. Robert Joseph Reeb Jr., MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 815 Pennsylvania Ave, Fort Worth, TX 76104 Phone: 817-321-0312 Fax: 817-317-7033 | |
Eugenia Payne, M.D Radiology Medicare: Accepting Medicare Assignments Practice Location: 815 Pennsylvania Ave, Fort Worth, TX 76104 Phone: 817-321-0404 | |
Prakash Gajera, Radiology Medicare: Medicare Enrolled Practice Location: 815 Pennsylvania Ave, Fort Worth, TX 76104 Phone: 817-321-0404 | |
Dr. Jeffrey Scott Wenzel, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 815 Pennsylvania Ave, Fort Worth, TX 76104 Phone: 817-321-0387 |