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NPI Code Detail

MEDICARE: MATTHEW MOORE

MEDICARE: MATTHEW MOORE
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
1207L00000XAnesthesiology Physician32242OK
2390200000XStudent in an Organized Health Care Education/Training ProgramOK

General Provider Information

NPI Number : 1912351123
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW MOORE
Provider Business Mailing Address
First Line : 13321 N MERIDIAN AVE
Second Line : STE 402
City : OKLAHOMA CITY
State : OK
Zip : 73120-8316
Country : US
Telephone Number : 405-271-4351
Fax Number :
Provider Business Practice Location Address
First Line : 750 NE 13TH ST STE 200
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73104-5024
Country : US
Telephone Number : 405-271-4351
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2016
Last Update Date : 03/30/2020

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Directions to “ MATTHEW MOORE ” Practice Location

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