MEDICARE: DUANE MOORE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	2005011345	MO
2	207P00000X	Emergency Medicine Physician	036136007	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00273332	OTHER	MO	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700973435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUANE MOORE M.D.

Provider Business Mailing Address
First Line	:	3691 RUTGER ST
Second Line	:	PROVIDER ENROLLMENT
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-2515
Country	:	US
Telephone Number	:	314-977-6828
Fax Number	:	314-977-6777

Provider Business Practice Location Address
First Line	:	3635 VISTA AVE
Second Line	:	WEST PAVILION, ROOM 315
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-2539
Country	:	US
Telephone Number	:	314-577-8776
Fax Number	:	314-268-5697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	01/14/2026

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Directions to “ DUANE MOORE M.D.” Practice Location

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