Provider Demographics
NPI:1396108981
Name:MOULTON, NATHANIEL GILBERT (MD)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:GILBERT
Last Name:MOULTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3001 QUAIL SPRINGS PKWY FL 5
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2640
Mailing Address - Country:US
Mailing Address - Phone:405-947-3345
Mailing Address - Fax:405-949-0849
Practice Address - Street 1:3366 NW EXPRESSWAY STE 660
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4416
Practice Address - Country:US
Practice Address - Phone:405-947-3345
Practice Address - Fax:405-949-0849
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK43273207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200108786Medicaid