Individual
DR. JACK ELLIS MOSELEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2600 E WILLOW RD, NORTHERN OKLAHOMA RESOURCE CENTER, ENID, OK 73701-8715
(580) 213-2700
(580) 548-2647
Mailing address
2600 E. WILLOW, NORTHERN OKLAHOMA RESOURCE CENTER, ENID, OK 73701-8715
(580) 213-2700
(580) 548-2647
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20477
OK
208000000X
Pediatrics Physician
20477
OK
Other
Enumeration date
11/30/2006
Last updated
08/26/2009
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