Individual
DR. JOHN T MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2905 S BRENTWOOD BLVD, SAINT LOUIS, MO 63144-2713
(636) 464-9333
(314) 461-6518
Mailing address
454 W JACKSON RD, SAINT LOUIS, MO 63119-3647
(636) 485-1524
(314) 461-6518
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2004005496
MO
208000000X
Pediatrics Physician
2004005496
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208738401
—
MO
Enumeration date
05/04/2006
Last updated
12/17/2024
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