Basic Information
| Provider Information | |||||||||
| NPI: | 1508371337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | JAN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 203 W DOUGLAS DR | ||||||||
| Address2: | |||||||||
| City: | MIDWEST CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731105513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057083414 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3000 UNITED FOUNDERS BLVD STE 239 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731124294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058407040 | ||||||||
| FaxNumber: | 4058407012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2017 | ||||||||
| LastUpdateDate: | 12/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | Y |
ID Information
| ID | Type | State | Issuer | Description | 17500000X | 01 | OK | 17500000X | OTHER |