Provider Demographics
NPI:1063775328
Name:MUIR, MONICA LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:LYNN
Last Name:MUIR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 6017B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8274
Mailing Address - Country:US
Mailing Address - Phone:314-251-7840
Mailing Address - Fax:314-251-4173
Practice Address - Street 1:621 S NEW BALLAS RD STE 6017B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-251-7840
Practice Address - Fax:314-251-4173
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017007169207R00000X, 208000000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics