Provider Demographics
NPI:1003182718
Name:MOORE, IMARI ELENA (MD)
Entity Type:Individual
Prefix:
First Name:IMARI
Middle Name:ELENA
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4140 W MEMORIAL RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8366
Mailing Address - Country:US
Mailing Address - Phone:405-242-4030
Mailing Address - Fax:405-242-4031
Practice Address - Street 1:4140 W MEMORIAL RD
Practice Address - Street 2:SUITE 215
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8366
Practice Address - Country:US
Practice Address - Phone:405-242-4030
Practice Address - Fax:405-242-4031
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK32252207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology