Healthcare Provider Details

I. General information

NPI: 1659318996
Provider Name (Legal Business Name): ANDREA K MOYER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/19/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S WOODS MILL RD SUITE 500 NORTH
CHESTERFIELD MO
63017-3625
US

IV. Provider business mailing address

222 S WOODS MILL RD SUITE 500 NORTH
CHESTERFIELD MO
63017-3625
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-6699
  • Fax: 314-590-5923
Mailing address:
  • Phone: 314-205-6699
  • Fax: 314-205-6985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2002014034
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: