Provider Demographics
NPI:1780109652
Name:PMO MEDICAL PLLC
Entity type:Organization
Organization Name:PMO MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-794-6008
Mailing Address - Street 1:701 W QUEENS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1785
Mailing Address - Country:US
Mailing Address - Phone:918-794-6008
Mailing Address - Fax:918-516-3447
Practice Address - Street 1:3807 W CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-2452
Practice Address - Country:US
Practice Address - Phone:918-514-7662
Practice Address - Fax:918-776-0955
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PMO MEDICAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty