Individual
DR. RICKY STUART MOFSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3535 S JEFFERSON AVE, SUITE 104, SAINT LOUIS, MO 63118-3930
(314) 776-7999
(314) 772-2257
Mailing address
PO BOX 4252, CHESTERFIELD, MO 63006-4252
(314) 776-7999
(314) 772-2257
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
R7J70
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14488
BNDD NUMBER
MO
01
—
R7J70
STATE LICENSE
MO
Enumeration date
10/25/2006
Last updated
03/07/2023
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