Healthcare Provider Details

I. General information

NPI: 1295311942
Provider Name (Legal Business Name): AVA MOORHEAD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

660 S EUCLID AVE
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-8274
  • Fax:
Mailing address:
  • Phone: 314-362-2382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VC0300X
TaxonomyComplex Family Planning Physician
License Number2026019190
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: