Individual
KENNETH EARL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
901 LINCOLN RD, IDABEL, OK 74745-7802
(580) 212-9785
Mailing address
300 HIGH ST, IDABEL, OK 74745-4023
(580) 208-2804
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-66
OK
Other
Enumeration date
06/26/2006
Last updated
07/08/2007
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