Healthcare Provider Details

I. General information

NPI: 1306163878
Provider Name (Legal Business Name): RODGER ALLEN MOORE HIS, HADF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 S HARVARD AVE STE A1
TULSA OK
74135-2612
US

IV. Provider business mailing address

4130 S HARVARD AVE STE A1
TULSA OK
74135-2612
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-1113
  • Fax: 918-749-1917
Mailing address:
  • Phone: 918-749-1113
  • Fax: 918-749-1917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number896
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: