Provider Demographics
NPI:1073187498
Name:HALLORAN, BENJAMIN TRAVIS (DO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:TRAVIS
Last Name:HALLORAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMANCHE COUNTY MEMORIAL HOSPITAL
Mailing Address - Street 2:3401 WEST GORE BLVD
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505
Mailing Address - Country:US
Mailing Address - Phone:210-978-6604
Mailing Address - Fax:
Practice Address - Street 1:COMANCHE COUNTY MEMORIAL HOSPITAL
Practice Address - Street 2:3401 WEST GORE BLVD
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:210-978-6604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK7690207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program