Healthcare Provider Details

I. General information

NPI: 1396035721
Provider Name (Legal Business Name): ARNOLD FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 ARNOLD MALL
ARNOLD MO
63010-2223
US

IV. Provider business mailing address

8 ARNOLD MALL
ARNOLD MO
63010-2223
US

V. Phone/Fax

Practice location:
  • Phone: 636-296-7510
  • Fax: 636-296-4041
Mailing address:
  • Phone: 636-296-7510
  • Fax: 636-296-4041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number110133
License Number StateMO

VIII. Authorized Official

Name: SANJAY SHARMA
Title or Position: DOCTOR
Credential: DO
Phone: 636-296-7510