Healthcare Provider Details

I. General information

NPI: 1457110033
Provider Name (Legal Business Name): JUSTIN MOREIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 06/30/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NE 10TH ST
OKLAHOMA CITY OK
73104-5418
US

IV. Provider business mailing address

8201 W BROWARD BLVD
PLANTATION FL
33324-2701
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-8001
  • Fax:
Mailing address:
  • Phone: 954-473-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number45951
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: