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General NPI Number Information
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NPI Number | 1306921812
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Entity Type | Individual
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Provider Name | RICKY STUART MOFSEN D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3535 S JEFFERSON AVE SUITE 104
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City | SAINT LOUIS
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State | MO
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Zip | 63118-3930
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Country | US
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Telephone | 314-776-7999
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Fax | 314-772-2257
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Provider Business Mailing Address
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Address Line | PO BOX 4252
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City | CHESTERFIELD
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State | MO
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Zip | 63006-4252
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Country | US
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Telephone | 314-776-7999
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Fax | 314-772-2257
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | R7J70
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License Number State | MO
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