Healthcare Provider Details

I. General information

NPI: 1932515475
Provider Name (Legal Business Name): JEFFREY MOORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2014
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 SW 89TH ST STE 200
OKLAHOMA CITY OK
73159-7909
US

IV. Provider business mailing address

3705 NW 63RD ST STE 201
OKLAHOMA CITY OK
73116-1937
US

V. Phone/Fax

Practice location:
  • Phone: 888-957-7463
  • Fax:
Mailing address:
  • Phone: 405-297-4968
  • Fax: 972-848-5269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD467707
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number36986
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: