Healthcare Provider Details

I. General information

NPI: 1396108981
Provider Name (Legal Business Name): NATHANIEL GILBERT MOULTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 NW EXPRESSWAY STE 660
OKLAHOMA CITY OK
73112-4416
US

IV. Provider business mailing address

3001 QUAIL SPRINGS PKWY FL 5
OKLAHOMA CITY OK
73134-2640
US

V. Phone/Fax

Practice location:
  • Phone: 405-947-3345
  • Fax: 405-949-0849
Mailing address:
  • Phone: 405-947-3345
  • Fax: 405-949-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number43273
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number43273
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: