Provider Demographics
NPI:1942614250
Name:MOORE, CATHERINE RUTH (DO)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:RUTH
Last Name:MOORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:12680 OLIVE BLVD
Mailing Address - Street 2:FAMILY MEDICINE
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6322
Mailing Address - Country:US
Mailing Address - Phone:314-251-8888
Mailing Address - Fax:314-251-8889
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:FAMILY MEDICINE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-8888
Practice Address - Fax:314-251-8889
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2014018093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine