Timothy D Moore, D.O. Valid NPI

Individual provider · Family Medicine Physician · O Fallon, MO

NPI

1396762910

Type

Individual (Type 1)

Primary specialty

Family Medicine Physician (Family Medicine)

Specialty group

Allopathic & Osteopathic Physicians

Taxonomy code

207Q00000X

License number

106405 (MO)

Sex

Male

Sole proprietor

No

Enumerated

2006-07-17

Last updated

2021-02-15