MARK ROLLO HALVERSON (NPI# 1619175890) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619175890 |
| Entity Type | Individual |
| Full Name | MARK ROLLO HALVERSON |
| Credential | MD |
| Practice Address |
816 W Cannon St Fort Worth TX 76104-3146 |
| Practice Telephone | 8173210387 |
| Mailing Telephone | 8173210387 |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2014-09-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085P0229X |
Radiology Specialization: Pediatric Radiology |
P8785 | TX | Allopathic & Osteopathic Physicians |
| N | 2085P0229X |
Radiology Specialization: Pediatric Radiology |
MD445798 | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 285250104 | 05 | |
| TX | 121715004 | 05 | |
| TX | 121715008 | 05 |
| Street Address |
816 W CANNON ST |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76104-3146 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710970975 | Radiology Associates of North Texas, Pa | Radiology | 816 W Cannon St, Credentialing 1710970975, Fort Worth, TX 76104-3146 | 2005-08-23 |
| 1124664982 | Brilyn Akerley | Physician Assistant | 816 W Cannon St, Fort Worth, TX 76104-3146 | 2019-11-26 |
| 1730539339 | Shanna Micheal Sherwood | Physician Assistant | 816 W Cannon St, Fort Worth, TX 76104-3146 | 2016-06-15 |
| 1518386325 | Jeremy Thomas Hall | Radiology | 816 W Cannon St, Fort Worth, TX 76104-3146 | 2014-04-09 |
| 1164849154 | Mohammad Toliyat | Radiology | 816 W Cannon St, Fort Worth, TX 76104-3146 | 2014-03-27 |
| 1407146384 | Radiology Associates of North Texas, Pa | Radiology | 816 W Cannon St, Credentialing 1407146384, Fort Worth, TX 76104-3146 | 2011-04-13 |
| 1861782740 | Radiology Associates of North Texas, Pa | Radiology | 816 W Cannon St, Credentialing 1861782740, Fort Worth, TX 76104-3146 | 2011-04-13 |
| 1629397245 | Daniel R. Eickenhorst | Radiology | 816 W Cannon St, Fort Worth, TX 76104-3146 | 2010-05-21 |
| 1508020736 | Steven Matthew Sharatz | Internal Medicine | 816 W Cannon St, Apt. 3, Fort Worth, TX 76104-3146 | 2008-07-16 |
| 1568620789 | Jonathan Martin Williams | Radiology | 816 W Cannon St, Fort Worth, TX 76104-3146 | 2008-05-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669082186 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 1115 8th St, Fort Worth, TX 76104 | 2020-08-10 |
| 1992343693 | Iris Giove | Psychologist | John Peter Smith Hospital, 1500 S. Main St., Fort Worth, TX 76104 | 2019-12-13 |
| 1104480656 | Swarnalaxmi Umapathy | Student in an Organized Health Care Education/Training Program | 900 8th Avenue, Fort Worth, TX 76104 | 2019-04-30 |
| 1881189132 | Mega Surgical Assistants LLC | Specialist/Technologist, Other | 1301pennsylvania, Fort Worth, TX 76104 | 2018-06-28 |
| 1356848899 | Tricia Kelly | Nurse Practitioner | 1325 Pennsylvania Avenue Suite 560, Fort Worth, TX 76104 | 2018-04-11 |
| 1952820979 | Modern Vein Clinic | Internal Medicine | 757 8th Avenue, Suite A, Forth Worth, TX 76104 | 2017-09-11 |
| 1790207165 | Vanessa Abbood | Dietitian, Registered | 900 Eighth Ave, Fns Department, Fort Worth, TX 76104 | 2017-07-07 |
| 1922537562 | Nicole Marie Tod | Student in an Organized Health Care Education/Training Program | 1500 S Main Street, Fort Worth, TX 76104 | 2017-06-07 |
| 1770025934 | Micah Bonola | Chiropractor | 1300 W. Rosedale St, Ste. A, Fort Worth, TX 76104 | 2016-11-04 |
| 1518315894 | United Bioscience, LLC. | Clinical Medical Laboratory | 901 W. Leuda St., B, Fort Worth, TX 76104 | 2016-05-27 |
| Find all providers in zip 76104 | ||||
| Taxonomy Code | 2085P0229X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Pediatric Radiology |
| A radiologist who is proficient in all forms of diagnostic imaging as it pertains to the treatment of diseases in the newborn, infant, child and adolescent. This specialist has knowledge of both imaging and interventional procedures related to the care and management of diseases of children. A pediatric radiologist must be highly knowledgeable of all organ systems as they relate to growth and development, congenital malformations, diseases peculiar to infants and children and diseases that begin in childhood but cause substantial residual impairment in adulthood. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053633727 | Thomas Stanley Lipscomb | Radiology | 4251 Sarita Ct, Fort Worth, TX 76109-4732 | 2010-02-23 |
| 1902199185 | Preetam Gongidi | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2011-05-23 |
| 1144401126 | Hayden Wilson Head IIi | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2007-11-19 |
| 1790995207 | Shelby Ryan Fierke | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2007-05-23 |
| 1376696658 | Adeka D Mcintosh | Radiology | 816 W Cannon St, 9th Floor, Fort Worth, TX 76104-3146 | 2007-01-19 |
| 1932164753 | Jamie Lynn Coleman | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2006-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770985103 | Ach Medical Imaging, LLC | Radiology | 9889 Bellaire Blvd Ste E202, Houston, TX 77036-3463 | 2014-09-17 |
| 1982889887 | Steven A Ross | Radiology | 4815 Alameda Avenue, El Paso, TX 79905-2705 | 2008-01-09 |
| 1336261403 | Rajvee M Shah | Radiology | 7168 Manor Oaks Dr, Dallas, TX 75248-2241 | 2007-04-06 |
| 1942377148 | Carmen Rene Emery | Radiology | 333 N. San Saba, River City Imaging Associates, San Antonio, TX 78207 | 2006-11-30 |
| 1174569842 | Mario E Ruiz | Radiology | 18126 Prestonshire, San Antonio, TX 78258-4473 | 2006-06-21 |
| 1053386326 | Linda Patricia Thomas | Radiology | 23814 Riata Cyn, San Antonio, TX 78258-4897 | 2006-02-21 |
| 1609499680 | Janina Patsch | Radiology | 6701 Fannin St Ste 470, Houston, TX 77030-2608 | 2020-05-25 |
| 1174037287 | Gilead Image Center | Radiology | 3910 N Jackson Rd, Pheer, TX 78577 | 2017-11-28 |
| 1700204427 | Atul Anant Utturkar | Radiology | 5323 Harry Hines Blvd, Dallas, TX 75390-7201 | 2014-03-31 |
| 1306284435 | Karen Lyons | Radiology | 6701 Fannin St, Suite 470, Houston, TX 77030-2608 | 2013-06-11 |
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| City | FORT WORTH |
| Zip Code | 76104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.