| NPI | 1811391386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH M MOORE Owner 918-936-4295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2020-12-07 |