Provider Demographics
NPI:1740306067
Name:MOINUDDIN, ASIF (MD)
Entity type:Individual
Prefix:DR
First Name:ASIF
Middle Name:
Last Name:MOINUDDIN
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 1:8985 S SWAN CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1717
Mailing Address - Country:US
Mailing Address - Phone:314-961-3121
Mailing Address - Fax:
Practice Address - Street 1:8985 S SWAN CIR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-1717
Practice Address - Country:US
Practice Address - Phone:314-961-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005010199207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine