Healthcare Provider Details

I. General information

NPI: 1649771874
Provider Name (Legal Business Name): PMO MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E BROADWAY CT STE A
SAND SPRINGS OK
74063-7931
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 918-246-3456
  • Fax: 918-516-3447
Mailing address:
  • Phone: 918-794-6008
  • Fax: 918-516-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

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