Healthcare Provider Details

I. General information

NPI: 1396706867
Provider Name (Legal Business Name): ARNOLD G BRODY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 DELMAR BLVD
SAINT LOUIS MO
63112-3005
US

IV. Provider business mailing address

700 VILLA CAPRI CT
SAINT LOUIS MO
63132-3604
US

V. Phone/Fax

Practice location:
  • Phone: 314-879-6363
  • Fax: 314-879-6372
Mailing address:
  • Phone: 314-707-8520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR4231
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR4231
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberR4231
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: