Provider Demographics
NPI:1144250887
Name:SPIRE, MOLLIE ANNE (DO)
Entity type:Individual
Prefix:DR
First Name:MOLLIE
Middle Name:ANNE
Last Name:SPIRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MOLLIE
Other - Middle Name:ANNE
Other - Last Name:HOSSFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5701 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-0937
Mailing Address - Country:US
Mailing Address - Phone:314-367-7848
Mailing Address - Fax:314-367-2985
Practice Address - Street 1:5701 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-0937
Practice Address - Country:US
Practice Address - Phone:314-367-7848
Practice Address - Fax:314-367-2985
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8948207Q00000X
MO2006010378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201283108Medicaid
MOI65313Medicare UPIN