Provider Demographics
NPI:1427025733
Name:MOELLER, FRANK DELBERT (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:DELBERT
Last Name:MOELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MEDICAL PLAZA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367
Mailing Address - Country:US
Mailing Address - Phone:636-561-8088
Mailing Address - Fax:636-561-1405
Practice Address - Street 1:300 MEDICAL PLAZA
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367
Practice Address - Country:US
Practice Address - Phone:636-561-8088
Practice Address - Fax:636-561-1405
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR531207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200848919Medicaid
A10853Medicare UPIN
MO002011541Medicare ID - Type Unspecified