DR. ISMAEL PEREZ MORENO (NPI# 1679716278) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679716278 |
| Entity Type | Individual |
| Full Name | DR. ISMAEL PEREZ MORENO |
| Credential | MD |
| Practice Address |
3635 Vista At Grand Desloge Towers, 2nd Floor St. Louis MO 63110 |
| Mailing Address |
1680 Stronsay Ct Folsom CA 95630-6224 |
| Practice Telephone | 3142685782 |
| Practice Fax Number | 3142685116 |
| Mailing Telephone | 9165011472 |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2020-02-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
C7-0004180 | DE | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
MT 184060 | PA | Allopathic & Osteopathic Physicians |
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
A117180 | CA | Allopathic & Osteopathic Physicians |
| N | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
2013030321 | MO | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3635 Vista At Grand, Desloge Towers, 2nd Floor, St. Louis, MO 63110 | 3142685782 | 3142685116 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689901480 | Ismael Moreno Jr. | Registered Nurse | 513 Feather Tree Dr, Clearwater, FL 33765-2456 | 2009-11-16 |
| Street Address |
3635 VISTA AT GRAND DESLOGE TOWERS, 2ND FLOOR |
| City | ST. LOUIS |
| State | MO |
| Zip Code | 63110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265675771 | Kimbell Kornu | Internal Medicine | 3635 Vista At Grand, Slu Hospital, St. Louis, MO 63110-2500 | 2009-04-14 |
| 1790855690 | Pamela Ann Golden | Clinical Nurse Specialist | 3635 Vista At Grand, St. Louis, MO 63110-0250 | 2006-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659971992 | Carrie Ellen Smith | Nurse Practitioner | Mailstop 90-00-174, One Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-10-27 |
| 1881210466 | Michelle Amanda Freilich | Internal Medicine | Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-06-19 |
| 1245856046 | Jeevin Shahi | Radiology | 3685 Vista Avenue, Center for Radiation Medicine, St. Louis, MO 63110 | 2020-06-18 |
| 1497371314 | Wilson Eduardo Rodriguez | Student in an Organized Health Care Education/Training Program | 1008 S. Spring, St Louis, MO 63110 | 2020-06-17 |
| 1578184065 | Kathryn Kay Lindsay | Registered Nurse | Saint Louis University Dept of Surgery, 3635 Vista Ave 3dt, St Louis, MO 63110 | 2020-05-06 |
| 1881232700 | Ashley Diane Pace | Nurse Practitioner | 1 Parkview Place, Shoenberg 6900, St. Louis, MO 63110 | 2019-12-11 |
| 1619520418 | Krithika Damodar Shenoy | Pathology | 660 Euclid Avenue, One Barnes Jewish Hospital Plaza, St. Louis, MO 63110 | 2019-07-20 |
| 1467912550 | Ian Ferguson | Dermatology | 660 S Euclid Ave., Cb 8123, St. Louis, MO 63110 | 2019-03-23 |
| 1760978688 | Ihab Hassanieh | Student in an Organized Health Care Education/Training Program | 33660 Vista Ave, St. Louis, MO 63110 | 2018-07-03 |
| 1336634500 | Martin K Mwangi | Pediatrics | 1 Childrens Place, 3s34, St. Louis, M, MO 63110 | 2018-06-28 |
| Find all providers in zip 63110 | ||||
| Taxonomy Code | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649396334 | William Edward Holloway | Radiology | 226 N Boyle Ave Apt 2n, Saint Louis, MO 63108-2922 | 2007-03-22 |
| 1740212299 | Vein Doctor LLC | Radiology | 2529 Glenn Hendren Dr Ste G60, Liberty, MO 64068-9607 | 2006-07-07 |
| 1952376170 | Jay Welch Albovias | Radiology | 201 Dunn Rd, Florissant, MO 63031-7928 | 2006-02-21 |
| 1548265960 | Dion Carlo Depaolis | Radiology | 2316 E Meyer Blvd, Kansas City, MO 64132-1136 | 2005-06-14 |
| 1851895718 | Allison Khoo | Radiology | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110 | 2018-03-23 |
| 1922530666 | Francisco Javier Gortes | Radiology | 1 Barnes Jew Hosp Plz, Saint Louis, MO 63110 | 2017-03-31 |
| 1154778959 | Jimmy Xu | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2016-05-21 |
| 1396152005 | Ahmed Abdelbaki | Radiology | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2014-07-14 |
| 1124446844 | Alexander Ushinsky | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110 | 2014-03-31 |
| 1144650938 | Diagnostic Radiology PC Vein Clinic | Radiology | 26136 Us Highway 59, Fairfax, MO 64446-9105 | 2013-11-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.