Individual
JASON ROBERT MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, D.O.
Contact information
Practice address
744 W 9TH ST, TULSA, OK 74127-9020
(918) 599-1000
Mailing address
744 W 9TH ST, TULSA, OK 74127-9020
(918) 599-1000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
6450
OK
225100000X
Physical Therapist
2452
NE
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025780200
—
NE
Enumeration date
08/05/2009
Last updated
05/06/2021
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