Provider Demographics
NPI:1508217514
Name:MOORE, ALLISON K (DO)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:K
Last Name:MOORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17166 N ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:OK
Mailing Address - Zip Code:73007-7115
Mailing Address - Country:US
Mailing Address - Phone:918-637-5552
Mailing Address - Fax:
Practice Address - Street 1:4200 S DOUGLAS AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3223
Practice Address - Country:US
Practice Address - Phone:405-636-7195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0151R207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine