Healthcare Provider Details

I. General information

NPI: 1497774616
Provider Name (Legal Business Name): MOORE EMERGENCY PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S TELEPHONE RD
MOORE OK
73160-2502
US

IV. Provider business mailing address

5925 N ANN ARBOR AVE
OKLAHOMA CITY OK
73122-7526
US

V. Phone/Fax

Practice location:
  • Phone: 405-793-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JERRY D BRINDLEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 405-604-6000