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NPI Code Detail

MEDICARE: JUSTIN DANIEL GARRETT MOORE

MEDICARE: JUSTIN DANIEL GARRETT MOORE
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1134054109
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN DANIEL GARRETT MOORE
Provider Business Mailing Address
First Line : 5310 E 31ST ST
Second Line :
City : TULSA
State : OK
Zip : 74135-5012
Country : US
Telephone Number : 918-600-3100
Fax Number :
Provider Business Practice Location Address
First Line : 5310 E 31ST ST
Second Line :
City : TULSA
State : OK
Zip : 74135-5012
Country : US
Telephone Number : 918-600-3100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2026
Last Update Date : 06/12/2026

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Directions to “ JUSTIN DANIEL GARRETT MOORE ” Practice Location

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