Healthcare Provider Details

I. General information

NPI: 1962414904
Provider Name (Legal Business Name): GERALD RAY HALE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 E 81ST ST SUITE 363
TULSA OK
74137-4250
US

IV. Provider business mailing address

2448 E 81ST ST SUITE 363
TULSA OK
74137-4250
US

V. Phone/Fax

Practice location:
  • Phone: 918-477-5950
  • Fax: 918-477-5951
Mailing address:
  • Phone: 918-477-5950
  • Fax: 918-477-5951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2619
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: