Provider Demographics
NPI:1861488306
Name:HALE, BRENT O JR (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:O
Last Name:HALE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:4500 S GARNETT RD
Mailing Address - Street 2:STE 919
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5229
Mailing Address - Country:US
Mailing Address - Phone:918-728-6145
Mailing Address - Fax:918-664-2521
Practice Address - Street 1:1200 EVERETT DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5047
Practice Address - Country:US
Practice Address - Phone:405-378-2197
Practice Address - Fax:405-378-2196
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
OK20311207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
G90941Medicare UPIN