Healthcare Provider Details

I. General information

NPI: 1568877702
Provider Name (Legal Business Name): DEPARTMENT OF THE AIR FORCE 72D MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 08/09/2025
Certification Date: 04/26/2023
Deactivation Date: 04/26/2023
Reactivation Date: 08/09/2025

III. Provider practice location address

7050 AIR DEPOT BLVD
TINKER AFB OK
73145-8716
US

IV. Provider business mailing address

DEPARTMENT OF THE AIR FORCE 72D MEDICAL GROUP 5700 ARNOLD ST
TINKER AFB OK
73145-8105
US

V. Phone/Fax

Practice location:
  • Phone: 405-582-6315
  • Fax: 405-736-2890
Mailing address:
  • Phone: 405-736-2890
  • Fax: 405-582-6315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2146555
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: CHIEF DHA PASS
Credential:
Phone: 210-536-6650