Organization
SOUTHERN OKLAHOMA PATHOLOGY ASSOC., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN WESLEY MOORING M. D. (OWNER)
(800) 288-8325
Entity
Organization
Contact information
Practice address
421 N MONTE VISTA ST, ADA, OK 74820-4609
(580) 332-9595
(580) 332-4921
Mailing address
421 N MONTE VISTA ST, PATHOLOGY DEPARTMENT, ADA, OK 74820-4609
(580) 332-9595
(580) 332-4921
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
8286
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100758421B
—
OK
01
—
CO5064
RAILROAD MEDICARE
OK
Enumeration date
08/31/2006
Last updated
08/28/2023
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