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General NPI Number Information
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NPI Number | 1639472681
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Entity Type | Organization
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Legal Business Name | MOC MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 12/14/2010
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Last Update Date | 07/01/2011
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Provider Practice Location Address
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Address Line | 3300 NW EXPRESSWAY
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-4418
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Country | US
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Telephone | 405-550-3572
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3931
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City | EDMOND
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State | OK
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Zip | 73083-3931
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Country | US
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Telephone | 405-550-3572
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. MANUEL O CRESPO
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Credential | DO
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Telephone | 405-550-3572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 3084
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License Number State | OK
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