Healthcare Provider Details

I. General information

NPI: 1639472681
Provider Name (Legal Business Name): MOC MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW EXPRESSWAY
OKLAHOMA CITY OK
73112-4418
US

IV. Provider business mailing address

PO BOX 3931
EDMOND OK
73083-3931
US

V. Phone/Fax

Practice location:
  • Phone: 405-550-3572
  • Fax:
Mailing address:
  • Phone: 405-550-3572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number3084
License Number StateOK

VIII. Authorized Official

Name: DR. MANUEL O CRESPO
Title or Position: ADMINISTRATOR
Credential: DO
Phone: 405-550-3572