Provider Demographics
NPI:1609218379
Name:MOORE, JOHN EASTER JR
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EASTER
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4926
Mailing Address - Country:US
Mailing Address - Phone:405-409-8952
Mailing Address - Fax:
Practice Address - Street 1:2032 SHEFFIELD RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4926
Practice Address - Country:US
Practice Address - Phone:405-409-8952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker