MEDICARE: BRENT O. HALE JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	20311	OK

General Provider Information

NPI Number	:	1861488306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT O. HALE JR. M.D.

Provider Business Mailing Address
First Line	:	4500 S GARNETT RD
Second Line	:	STE 919
City	:	TULSA
State	:	OK
Zip	:	74146-5229
Country	:	US
Telephone Number	:	918-728-6145
Fax Number	:	918-664-2521

Provider Business Practice Location Address
First Line	:	1200 EVERETT DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5047
Country	:	US
Telephone Number	:	405-378-2197
Fax Number	:	405-378-2196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/08/2007

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