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General NPI Number Information
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NPI Number | 1184707143
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Entity Type | Individual
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Provider Name | JEREMY ADAM MOORE MD
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 05/16/2019
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Provider Practice Location Address
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Address Line | 3650 W ROCK CREEK RD SUITE 110
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City | NORMAN
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State | OK
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Zip | 73072-2202
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Country | US
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Telephone | 405-364-2666
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Fax | 405-364-9627
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Provider Business Mailing Address
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Address Line | 3033 NW 63RD ST STE 152
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-3607
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Country | US
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Telephone | 405-755-6651
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Fax | 405-755-2795
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 25527
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License Number State | OK
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