Provider Demographics
NPI:1285852368
Name:SAMANTHA C MOERY DO PC
Entity Type:Organization
Organization Name:SAMANTHA C MOERY DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOERY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-237-1877
Mailing Address - Street 1:3201 N VAN BUREN ST
Mailing Address - Street 2:400
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-1800
Mailing Address - Country:US
Mailing Address - Phone:580-237-1877
Mailing Address - Fax:580-237-2872
Practice Address - Street 1:3201 N VAN BUREN ST
Practice Address - Street 2:400
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-1800
Practice Address - Country:US
Practice Address - Phone:580-237-1877
Practice Address - Fax:580-237-2872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4317207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4317OtherSTATE MEDICAL LICENSE
OKP00442024OtherRAILROAD MEDICARE
OKP00442024OtherRAILROAD MEDICARE