Individual
EVAN ROBERT MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5020 E 68TH ST, TULSA, OK 74136-3307
(918) 492-3636
Mailing address
5020 E 68TH ST, TULSA, OK 74136-3307
(918) 492-3636
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
28974
OK
Other
Enumeration date
05/17/2007
Last updated
05/18/2012
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