Individual
TIMOTHY D MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2630 HIGHWAY K, O FALLON, MO 63368-6624
(636) 240-5454
(636) 980-5335
Mailing address
2630 HIGHWAY K, O FALLON, MO 63368-6624
(636) 240-5454
(636) 980-5335
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
106405
MO
207Q00000X
Family Medicine Physician
Primary
106405
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396762910
—
MO
05
—
245208616
—
MO
Enumeration date
07/17/2006
Last updated
02/15/2021
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