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General NPI Number Information
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NPI Number | 1285852368
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Entity Type | Organization
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Legal Business Name | SAMANTHA C MOERY DO PC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 3201 N VAN BUREN ST 400
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City | ENID
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State | OK
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Zip | 73703-1800
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Country | US
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Telephone | 580-237-1877
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Fax | 580-237-2872
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Provider Business Mailing Address
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Address Line | 3201 N VAN BUREN ST 400
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City | ENID
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State | OK
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Zip | 73703-1800
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Country | US
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Telephone | 580-237-1877
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Fax | 580-237-2872
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMANTHA C MOERY
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Credential | D.O.
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Telephone | 580-237-1877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4317
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License Number State | OK
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