# SOUTH MOORE MEDICAL CLINIC,PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** South Moore Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972545218
- **Authorized official:** KEITH R. LAYNE M.D. (PHYSICIAN)
- **Authorized official phone:** (405) 912-4900

## Contact information

- **Practice address:** 14800 S WESTERN AVE, MOORE, OK 73170-7112
- **Practice address phone:** (405) 912-4900
- **Practice address fax:** (405) 912-4903
- **Mailing address:** PO BOX 25887, OKLAHOMA CITY, OK 73125-0887
- **Mailing address phone:** (405) 912-4900
- **Mailing address fax:** (405) 912-4903

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/12/2006
- **Last updated:** 08/22/2020