Healthcare Provider Details

I. General information

NPI: 1144328089
Provider Name (Legal Business Name): DEBORAH MOORE L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH OSBURN L.D.

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W MEMORIAL RD
OKLAHOMA CITY OK
73120-8304
US

IV. Provider business mailing address

4401 W MEMORIAL RD SUITE #141; ATTN: TERRI
OKLAHOMA CITY OK
73134-1785
US

V. Phone/Fax

Practice location:
  • Phone: 405-752-3758
  • Fax: 405-936-5288
Mailing address:
  • Phone: 405-936-5800
  • Fax: 405-936-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1247
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: