Healthcare Provider Details

I. General information

NPI: 1013288984
Provider Name (Legal Business Name): JOHN E MOORE II M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E SHERIDAN AVE STE 2
OKLAHOMA CITY OK
73104-4209
US

IV. Provider business mailing address

222 E SHERIDAN AVE STE 2
OKLAHOMA CITY OK
73104-4209
US

V. Phone/Fax

Practice location:
  • Phone: 405-200-0131
  • Fax: 405-270-0543
Mailing address:
  • Phone: 405-200-0131
  • Fax: 405-270-0543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: