Healthcare Provider Details

I. General information

NPI: 1063536233
Provider Name (Legal Business Name): MOORE PRIMARY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SE 4TH ST STE H
MOORE OK
73160-7328
US

IV. Provider business mailing address

PO BOX 25016
OKLAHOMA CITY OK
73125-0016
US

V. Phone/Fax

Practice location:
  • Phone: 405-799-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2438
License Number StateOK

VIII. Authorized Official

Name: RANDALL A CARTER
Title or Position: OWNER
Credential: PA
Phone: 405-799-7400