Healthcare Provider Details

I. General information

NPI: 1245298389
Provider Name (Legal Business Name): DOUGLAS R. MOORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DOUG R MOORE M.D.

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 S GARNETT RD
TULSA OK
74129-5101
US

IV. Provider business mailing address

PO BOX 22063 DEPT 0289
TULSA OK
74121-2063
US

V. Phone/Fax

Practice location:
  • Phone: 918-665-1520
  • Fax: 405-749-4561
Mailing address:
  • Phone: 405-751-4664
  • Fax: 405-749-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9916
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: