Provider Demographics
NPI:1083756548
Name:MID-DEL FAMILY PHYSICIANS, LLC
Entity Type:Organization
Organization Name:MID-DEL FAMILY PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-736-6811
Mailing Address - Street 1:1212 S DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5246
Mailing Address - Country:US
Mailing Address - Phone:405-736-6811
Mailing Address - Fax:405-736-6863
Practice Address - Street 1:1212 S DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5246
Practice Address - Country:US
Practice Address - Phone:405-736-6811
Practice Address - Fax:405-736-6863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200030280AMedicaid
OK200030280AMedicaid