Healthcare Provider Details

I. General information

NPI: 1851786412
Provider Name (Legal Business Name): ANDREW JOSEPH HALE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 S JACKSON AVE STE 225
TULSA OK
74127-9049
US

IV. Provider business mailing address

5310 E 31ST ST STE 13
TULSA OK
74135-5013
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-7711
  • Fax: 918-583-5831
Mailing address:
  • Phone: 918-561-5701
  • Fax: 918-561-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5984
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: