Individual
JACOB EZRA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13913 S WESTERN AVE, OKLAHOMA CITY, OK 73170-7011
(405) 445-5567
Mailing address
18301 HORSESHOE DR, JONES, OK 73049-8124
(806) 802-4056
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-450983
OK
Other
Enumeration date
07/08/2025
Last updated
07/08/2025
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