Provider Demographics
NPI:1114014867
Name:MOORE, TERRY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1402 S GRAND BLVD RM R213A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1004
Mailing Address - Country:US
Mailing Address - Phone:314-977-8838
Mailing Address - Fax:314-977-8818
Practice Address - Street 1:1225 S. GRAND
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104
Practice Address - Country:US
Practice Address - Phone:314-977-8838
Practice Address - Fax:314-977-8818
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2021-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO34667207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A12434Medicare UPIN