Individual
DR. JUSTIN DEAN MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106
(314) 525-1906
Mailing address
PO BOX 776084, CHICAGO, IL 60677-6084
(314) 364-4200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036119226
IL
207P00000X
Emergency Medicine Physician
Primary
2008014393
MO
207Q00000X
Family Medicine Physician
2008014393
MO
Other
Enumeration date
05/30/2007
Last updated
04/21/2026
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