Provider Demographics
NPI:1265454722
Name:HALFORD, JEFFREY LEON (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEON
Last Name:HALFORD
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 1:5421 E 120TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-8804
Mailing Address - Country:US
Mailing Address - Phone:918-779-3963
Mailing Address - Fax:918-856-3736
Practice Address - Street 1:6161 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1902
Practice Address - Country:US
Practice Address - Phone:918-494-4250
Practice Address - Fax:918-856-3736
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3924208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100126340DMedicaid
OK243533202Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER