Individual
MR. DEREK ALAN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2647 NW 49TH ST, OKLAHOMA CITY, OK 73112-8265
(405) 202-9516
Mailing address
2647 NW 49TH ST, OKLAHOMA CITY, OK 73112-8265
(405) 202-9516
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
06/15/2024
Last updated
06/15/2024
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