Provider Demographics
NPI:1023073491
Name:HALBROOK, LINDA SHELTON (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SHELTON
Last Name:HALBROOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:FAY
Other - Last Name:GAUDET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2520 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2052
Mailing Address - Country:US
Mailing Address - Phone:972-234-3311
Mailing Address - Fax:972-669-8072
Practice Address - Street 1:2520 N CENTRAL EXPY
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2052
Practice Address - Country:US
Practice Address - Phone:972-234-3311
Practice Address - Fax:972-669-8072
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080168923OtherRR MEDICARE
TX8A4586OtherBC/BS
TXB23262Medicare UPIN
TX8147K7Medicare ID - Type Unspecified