Provider Demographics
NPI:1215148952
Name:MOORE, SATHEAVY (MD)
Entity type:Individual
Prefix:DR
First Name:SATHEAVY
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11475 OLDE CABIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7128
Mailing Address - Country:US
Mailing Address - Phone:314-991-8200
Mailing Address - Fax:314-569-1787
Practice Address - Street 1:901 PATIENTS FIRST DR
Practice Address - Street 2:DEPT OF RADIOLOGY
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4700
Practice Address - Country:US
Practice Address - Phone:636-390-1575
Practice Address - Fax:636-390-9710
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2016-05-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO20100075912085R0202X
IL0361282442085R0202X
LAMD2011662085R0202X
ARE80902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1215148952Medicaid
MO102880014Medicare PIN
MO107690017Medicare PIN