Provider Demographics
NPI:1164459772
Name:MOORE, SUE D (MD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:D
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:12639 OLD TESSON RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:314-849-0311
Mailing Address - Fax:314-849-4423
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 2009B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-6880
Practice Address - Fax:314-251-6919
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO113681207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO338322OtherHEALTHLINK
MO113282OtherBLUE CROSS BLUE SHIELD
MO6715780OtherCIGNA
MO4454848OtherAETNA
MO272132OtherGROUP HEALTHPLAN
MO7400110OtherUNITED HEALTHCARE
MO113282OtherBLUE CROSS BLUE SHIELD