# WEATHERFORD FAMILY PRACTICE MEDICAL CENTER PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528204567
- **Authorized official:** DR. TAMALA ROCHELLE MALLETT MOORE M.D. (OWNER/MEDICAL DOCTOR)
- **Authorized official phone:** (580) 772-2400

## Contact information

- **Practice address:** 3739 LEGACY, WEATHERFORD, OK 73096-9746
- **Practice address phone:** (580) 772-2400
- **Practice address fax:** (580) 772-2408
- **Mailing address:** 3739 LEGACY, WEATHERFORD, OK 73096-9746
- **Mailing address phone:** (580) 772-2400
- **Mailing address fax:** (580) 772-2408

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 26755 | OK | Yes |

## Other

- **Enumeration date:** 12/22/2008
- **Last updated:** 01/24/2011