=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063452787
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PIERRE MOESER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2006
-----------------------------------------------------
Last Update Date | 10/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 JUNGERMANN CIR STE 300
-----------------------------------------------------
City | SAINT PETERS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63376-1622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-916-9020
-----------------------------------------------------
Fax | 636-916-9021
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 670 MASON RIDGE CENTER DR STE 300
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-8573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-916-9020
-----------------------------------------------------
Fax | 636-916-9021
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 82570
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 101868
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------