Individual
MALLORY JO HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4444 E 41ST ST, TULSA, OK 74135-2527
(918) 619-4400
(918) 619-4152
Mailing address
4502 E 41ST ST, TULSA, OK 74135-2536
(918) 619-4400
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
6982
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201098000A
—
OK
Enumeration date
03/25/2019
Last updated
09/22/2022
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