Individual
MR. MICHAEL L MOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2115
Mailing address
PO BOX 504274, SAINT LOUIS, MO 63150-4274
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2005012338
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619937893
—
MO
01
—
440552485
TRICARE
MO
01
—
P01034638
MCR RR
MO
Enumeration date
03/23/2006
Last updated
02/13/2014
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