Provider Demographics
NPI:1447229802
Name:HALLUM, ALTON VENSON (MD)
Entity type:Individual
Prefix:
First Name:ALTON
Middle Name:VENSON
Last Name:HALLUM
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:PO BOX 910221
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-0221
Mailing Address - Country:US
Mailing Address - Phone:520-519-7700
Mailing Address - Fax:
Practice Address - Street 1:1845 W ORANGE GROVE RD
Practice Address - Street 2:BLDG 2
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-531-8967
Practice Address - Fax:520-742-7180
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21585207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ140426Medicaid
AZ860938204OtherTIN
AZZ62023Medicare PIN
AZE96170Medicare UPIN