Healthcare Provider Details

I. General information

NPI: 1124017934
Provider Name (Legal Business Name): BETTY HARMON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MAGNOLIA CT ST 102 STE 102
MOORE OK
73160
US

IV. Provider business mailing address

1200 MAGNOLIA CT ST 102 STE 102
MOORE OK
73160
US

V. Phone/Fax

Practice location:
  • Phone: 405-912-3100
  • Fax: 405-912-3104
Mailing address:
  • Phone: 405-650-5470
  • Fax: 405-261-9266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17592
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: