Moore, Timothy D
Moore, Timothy D is an individual health care provider with primary practice located at 2630 Highway K , O Fallon MO 63368-6624. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Moore, Timothy D can be contacted via phone (636) 240-5454.Contact Information
Primary practice address
2630 Highway K
O Fallon MO 63368-6624
Phone: (636) 240-5454
Fax: (636) 980-5335
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 106405 | Missouri |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 106405 | Missouri |
Profile Details
| NPI number | 1396762910 |
|---|---|
| LBN Legal business name | Moore, Timothy D |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 17th, 2006 |
| Last updated | Feb 15th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1396762910 | NPPES |
| Missouri | MEDICAID | 245208616 | |
| Missouri | MEDICAID | 1396762910 |
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