Provider Demographics
NPI:1457306516
Name:MOREY, KIRK PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:PATRICK
Last Name:MOREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12990 MANCHESTER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1804
Mailing Address - Country:US
Mailing Address - Phone:314-432-6137
Mailing Address - Fax:314-432-1237
Practice Address - Street 1:12990 MANCHESTER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1804
Practice Address - Country:US
Practice Address - Phone:314-432-6137
Practice Address - Fax:314-432-1237
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR3G46207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202700811Medicaid
MO202700811Medicaid
MO000005786Medicare PIN