Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 32252 | OK |
NPI | 1003182718 |
---|---|
Provider Name | Imari Elena Moore |
First Address | Oklahoma City, OK 73120-8366 |
Second Address | Oklahoma City, OK 73120-8366 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2012 |
Last Update Date | 07/09/2016 |