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General NPI Number Information
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NPI Number | 1508065244
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Entity Type | Individual
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Provider Name | JACOB ANDREW MOORE D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 10/21/2014
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Provider Practice Location Address
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Address Line | 1111 N LEE AVE SUITE 300
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-2600
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Country | US
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Telephone | 405-272-7005
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Fax | 405-272-7391
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Provider Business Mailing Address
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Address Line | PO BOX 268986
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City | OKLAHOMA CITY
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State | OK
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Zip | 73126-8986
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Country | US
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Telephone | 405-231-3857
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Fax | 405-272-7977
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4541
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License Number State | OK
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