Provider Demographics
NPI:1306163878
Name:MOORE, RODGER ALLEN (HIS, HADF)
Entity type:Individual
Prefix:
First Name:RODGER
Middle Name:ALLEN
Last Name:MOORE
Suffix:
Gender:M
Credentials:HIS, HADF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 S HARVARD AVE STE A1
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2612
Mailing Address - Country:US
Mailing Address - Phone:918-749-1113
Mailing Address - Fax:918-749-1917
Practice Address - Street 1:4130 S HARVARD AVE STE A1
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2612
Practice Address - Country:US
Practice Address - Phone:918-749-1113
Practice Address - Fax:918-749-1917
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK896237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist