Healthcare Provider Details

I. General information

NPI: 1003182718
Provider Name (Legal Business Name): IMARI ELENA MOORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W MEMORIAL RD
OKLAHOMA CITY OK
73120-8304
US

IV. Provider business mailing address

4140 W MEMORIAL RD STE 321
OKLAHOMA CITY OK
73120-8300
US

V. Phone/Fax

Practice location:
  • Phone: 57-484-7264
  • Fax: 405-607-8497
Mailing address:
  • Phone: 405-748-4726
  • Fax: 405-242-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number32252
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: