Provider Demographics
NPI:1245257922
Name:MOSHER, AMY A (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:MOSHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WESTPORT PLZ
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3109
Mailing Address - Country:US
Mailing Address - Phone:314-548-4772
Mailing Address - Fax:314-548-4748
Practice Address - Street 1:3015 N NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-966-5180
Practice Address - Fax:314-821-2180
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4H512085R0202X
IL0361142482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
24349OtherBLUE CHOICE
018012444OtherCARE
300066996OtherRR CARE
6661OtherHCARE USA
018012444OtherMO CARE
398021OtherHLT PART
010013128OtherMO CARE
1390OtherMO BLUE
203077003OtherMO CAID
300066989OtherRR CARE
E12419OtherGATE WAY
431725842MIDOtherMERCY
141835OtherH LINK
203077003OtherMC MCAID
2781OtherGHP
0090000352OtherIL BLUE
1650512OtherPH PLAN
398021OtherHLT PART
300066989OtherRR CARE