Individual
DR. CHARLES S MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12700 SOUTHFORK RD STE 175, SAINT LOUIS, MO 63128-3209
(314) 525-1798
(314) 525-4469
Mailing address
12700 SOUTHFORK RD STE 175, SAINT LOUIS, MO 63128-3209
(314) 525-1798
(314) 525-4469
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2013017434
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200045550A
—
OK
Enumeration date
01/27/2006
Last updated
05/01/2025
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