Provider Demographics
NPI:1952398430
Name:MUCCINI, JOSEPH A JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:MUCCINI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:222 S WOODS MILL RD
Mailing Address - Street 2:475 NORTH
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-878-0600
Mailing Address - Fax:314-878-0602
Practice Address - Street 1:222 S WOODS MILL RD
Practice Address - Street 2:475 NORTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-878-0600
Practice Address - Fax:314-878-0602
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO111874207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO382640OtherHEALTHLINK
MO64524OtherGROUP HEALTH PLAN
MO8623544001OtherCIGNA
MO1182892OtherFIRST HEALTH
MO000000660531OtherANTHEM
MOSTL0308700OtherUNITED HEALTH CARE
MO5672603OtherAETNA
MOP00849497OtherMEDICARE RR
MOMA2141001Medicare PIN