1689772162 NPI number — JEFFREY L. HALFORD, DO, PLLC

Table of content: (NPI 1689772162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689772162 NPI number — JEFFREY L. HALFORD, DO, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY L. HALFORD, DO, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689772162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5421 E 120TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74137-8804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-779-3963
Provider Business Mailing Address Fax Number:
918-856-3736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 W QUEENS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROKEN ARROW
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74012-1784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-794-6008
Provider Business Practice Location Address Fax Number:
918-516-3447
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALFORD
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DO
Authorized Official Telephone Number:
918-779-3963

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  3924 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100126340E , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com