Provider Demographics
NPI:1689013351
Name:MORENO, JONATHAN DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DANIEL
Last Name:MORENO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-1291
Mailing Address - Fax:314-362-4278
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DIV IM CARDIOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-362-1291
Practice Address - Fax:314-362-4278
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2024-04-10
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Provider Licenses
StateLicense IDTaxonomies
MO2014039569207RA0001X, 207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200064734Medicaid