Individual
MARY KATHLEEN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3104
(918) 458-3580
Mailing address
PO BOX 675, TAHLEQUAH, OK 74465-0675
(918) 458-5583
(918) 458-3580
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
3976
OK
Other
Enumeration date
07/06/2006
Last updated
07/08/2007
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