Provider Demographics
NPI:1528039419
Name:MOORE, RUTH E (DO)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:E
Last Name:MOORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8131 S MEMORIAL DR
Mailing Address - Street 2:STE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4347
Mailing Address - Country:US
Mailing Address - Phone:918-872-6880
Mailing Address - Fax:918-293-3155
Practice Address - Street 1:8131 S MEMORIAL DR
Practice Address - Street 2:STE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4347
Practice Address - Country:US
Practice Address - Phone:918-872-6880
Practice Address - Fax:918-293-3155
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK4228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200043890AMedicaid
243505504Medicare ID - Type Unspecified
I25328Medicare UPIN