Provider Demographics
NPI:1326148123
Name:JEFFREY S HALSELL DO PLLC
Entity Type:Organization
Organization Name:JEFFREY S HALSELL DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HALSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-728-8020
Mailing Address - Street 1:9308 S TOLEDO AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2739
Mailing Address - Country:US
Mailing Address - Phone:918-615-6581
Mailing Address - Fax:918-893-1242
Practice Address - Street 1:9308 S TOLEDO AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2739
Practice Address - Country:US
Practice Address - Phone:918-728-8020
Practice Address - Fax:918-728-8019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37292081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100103150DMedicaid
OK300522075Medicare PIN