Provider Demographics
NPI:1487787909
Name:GERALD R HALE DO PLLC
Entity type:Organization
Organization Name:GERALD R HALE DO PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-477-5950
Mailing Address - Street 1:2448 E 81ST ST
Mailing Address - Street 2:SUITE 363
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4250
Mailing Address - Country:US
Mailing Address - Phone:918-477-5950
Mailing Address - Fax:918-477-5951
Practice Address - Street 1:2448 E 81ST ST
Practice Address - Street 2:SUITE 363
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4250
Practice Address - Country:US
Practice Address - Phone:918-477-5950
Practice Address - Fax:918-477-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200037360AMedicaid
OK200037360AMedicaid