Individual
MR. ROBERT GENE MOULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5801 E 41ST ST STE 900, TULSA, OK 74135-5631
(918) 747-4975
(918) 743-8552
Mailing address
PO BOX 4930, TULSA, OK 74159-0930
(918) 747-4975
(918) 743-8552
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
3824
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100183610A
—
OK
01
—
300120729
RAILROAD MEDICARE
OK
01
—
300129663
RAILROAD MEDICARE
OK
Enumeration date
11/21/2005
Last updated
08/05/2024
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