Individual
MR. MATTHEW HENRY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
111 S TREATY RD, MIAMI, OK 74354
(918) 540-1511
(918) 542-7374
Mailing address
111 S TREATY RD, MIAMI, OK 74354-5327
(918) 540-1511
(918) 542-7374
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1732
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100736700O
—
OK
05
—
200207110A
—
OK
Enumeration date
05/13/2008
Last updated
01/07/2019
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