Provider Demographics
NPI:1043431885
Name:MOORE, LAURA IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:IRENE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:224 SOUTH WOODS MILL ROAD
Mailing Address - Street 2:SUITE 750
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3623
Mailing Address - Country:US
Mailing Address - Phone:314-576-9797
Mailing Address - Fax:314-469-7517
Practice Address - Street 1:224 SOUTH WOODS MILL ROAD
Practice Address - Street 2:SUITE 750
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3623
Practice Address - Country:US
Practice Address - Phone:314-576-9797
Practice Address - Fax:314-469-7517
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2012-01-24
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Provider Licenses
StateLicense IDTaxonomies
MO2007009842207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO311700426Medicare PIN