Provider Demographics
NPI:1881683613
Name:MORELAND, HARRIS J (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:J
Last Name:MORELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 SE DEBELL
Mailing Address - Street 2:BLDG A
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006
Mailing Address - Country:US
Mailing Address - Phone:918-331-1045
Mailing Address - Fax:918-331-1051
Practice Address - Street 1:224 SE DEBELL
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006
Practice Address - Country:US
Practice Address - Phone:918-331-1045
Practice Address - Fax:918-331-1051
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10136208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100139430AMedicaid
OK731028732-001OtherBC BS OK
OK100139430AMedicaid