Healthcare Provider Details

I. General information

NPI: 1780109652
Provider Name (Legal Business Name): PMO MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 W CHEROKEE AVE
SALLISAW OK
74955-2452
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 918-514-7662
  • Fax: 918-776-0955
Mailing address:
  • Phone: 918-794-6008
  • Fax: 918-516-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

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