Basic Information
| Provider Information | |||||||||
| NPI: | 1326148123 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEFFREY S HALSELL DO PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9308 S TOLEDO AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741372739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186156581 | ||||||||
| FaxNumber: | 9188931242 | ||||||||
| Practice Location | |||||||||
| Address1: | 9308 S TOLEDO AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741372739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187288020 | ||||||||
| FaxNumber: | 9187288019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 12/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | HALSELL | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | DO | ||||||||
| AuthorizedOfficialTelephone: | 9187288020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 12/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | 3729 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100103150D | 05 | OK | MEDICAID |