Provider Demographics
NPI:1689772162
Name:JEFFREY L. HALFORD, DO, PLLC
Entity Type:Organization
Organization Name:JEFFREY L. HALFORD, 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:L
Authorized Official - Last Name:HALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-779-3963
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 1:701 W QUEENS ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1784
Practice Address - Country:US
Practice Address - Phone:918-794-6008
Practice Address - Fax:918-516-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3924208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100126340EMedicaid
OK100126340EMedicaid