| NPI | 1952994832 |
|---|---|
| Doing Business As | SSM HEALTH MEDICAL GROUP MOORE PRIMARY CARE |
| Entity Type | Organization |
| Authorized Contact | CRYSTAL L PENA Provider Enrollment 405-272-7452 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2021-02-11 |