Provider Demographics
NPI:1679886477
Name:MOORE, ANGEL ONDRIA
Entity type:Individual
Prefix:MS
First Name:ANGEL
Middle Name:ONDRIA
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22700 COUNTY ROAD 140
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OK
Mailing Address - Zip Code:73077-9405
Mailing Address - Country:US
Mailing Address - Phone:580-307-4818
Mailing Address - Fax:
Practice Address - Street 1:102 E FIR ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-4900
Practice Address - Country:US
Practice Address - Phone:580-336-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator