Healthcare Provider Details

I. General information

NPI: 1437638228
Provider Name (Legal Business Name): PMO MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 E CLARK BASS BLVD STE 205
MCALESTER OK
74501-4285
US

IV. Provider business mailing address

701 W QUEENS ST STE 100
BROKEN ARROW OK
74012-1785
US

V. Phone/Fax

Practice location:
  • Phone: 918-421-8897
  • Fax:
Mailing address:
  • Phone: 918-794-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number3924
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY HALFORD
Title or Position: PHYSICIAN / OWNER
Credential: DO
Phone: 918-794-6008