| Doctor Name: | DR. PHILLIP WAYNE HALCUM |
| NPI Number: | 1013972884 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 91-62 |
| Business Practice Address: | 109 Kerr Ave Poteau, OK - 749535270 |
| Business Phone Number: | 9186491100 |
| Business Fax Number: | 9186491199 |
| Mailing Address: | 8625 Cove Cir, HACKETT |
| State: | AR |
| Postal Code: | 729374161 |
| Phone Number: | 5016900298 |
| Fax Number: | 9186491199 |
| NPI Enumeration Date: | 04/17/2006 |
| NPI Last Update Date: | 07/29/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | 91-62 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |