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General NPI Number Information
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NPI Number | 1295977064
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Entity Type | Organization
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Legal Business Name | WESTERN MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 2149 SW 59TH ST SUITE NO. 104
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City | OKLAHOMA CITY
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State | OK
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Zip | 73119-7033
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Country | US
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Telephone | 405-708-4686
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Fax | 866-611-2570
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Provider Business Mailing Address
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Address Line | 2149 SW 59TH ST SUITE NO. 104
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City | OKLAHOMA CITY
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State | OK
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Zip | 73119-7033
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Country | US
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Telephone | 405-708-4686
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Fax | 866-611-2570
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Authorized Official
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Title or Position | PRESIDENT/MEDICAL DIRECTOR
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Name | DR. CECIL ALLEN MOORE
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Credential | DO
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Telephone | 405-708-4686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 03777
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License Number State | OK
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