MEDICARE: C.V. MOSES, D.O. INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710139076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C.V. MOSES, D.O. INC.

Provider Business Mailing Address
First Line	:	8222 S. HARVARD AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-1613
Country	:	US
Telephone Number	:	918-493-3838
Fax Number	:

Provider Business Practice Location Address
First Line	:	8222 S. HARVARD AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-1613
Country	:	US
Telephone Number	:	918-493-3838
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	CHRISTOPER VINCENT MOSES
Credential	:	D.O.
Telephone Number	:	918-493-3838

Provider Enumeration Date	:	10/17/2008
Last Update Date	:	11/11/2008

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