Individual
DR. SUE D MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
621 S NEW BALLAS RD, SUITE 2009B, SAINT LOUIS, MO 63141-8232
(314) 251-6880
(314) 251-6919
Mailing address
12639 OLD TESSON RD, SUITE 115, SAINT LOUIS, MO 63128-2786
(314) 849-0311
(314) 849-4423
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
113681
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113282
BLUE CROSS BLUE SHIELD
MO
01
—
272132
GROUP HEALTHPLAN
MO
01
—
338322
HEALTHLINK
MO
01
—
4454848
AETNA
MO
01
—
6715780
CIGNA
MO
01
—
7400110
UNITED HEALTHCARE
MO
Enumeration date
06/27/2006
Last updated
07/08/2007
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