Ronald Lynn Moore Sr., BEHAVIOR ANALYST
Individual provider Active NPI Behavior Analyst · Spencer, OK
NPI 1114367646 · NPPES record last updated Jun 28, 2013
Key facts
- NPI
- 1114367646
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- Practice address
- 5720 Oakwood St
Spencer, OK 73084-8639 - Phone
- (405) 408-9723
- NPI assigned
- Jun 28, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | OK | Yes |
Addresses
Primary practice location
5720 Oakwood St
Spencer, OK 73084-8639
Mailing address
5720 Oakwood St
Spencer, OK 73084-8639
Phone (405) 408-9723
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200025790-B | Medicaid | OK |
Other providers in Spencer, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.