Healthcare Provider Details

I. General information

NPI: 1285980821
Provider Name (Legal Business Name): SOUTHWEST ORTHOPAEDIC SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 HAYES AVE
CLINTON OK
73601-3601
US

IV. Provider business mailing address

8100 S. WALKER AVENUE BUILDING A
OKLAHOMA CITY OK
73139-9404
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-8688
  • Fax: 405-631-4964
Mailing address:
  • Phone: 405-632-4468
  • Fax: 405-631-4964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES DAVID MOORE
Title or Position: ADMINISTRATOR
Credential:
Phone: 405-632-4468