Healthcare Provider Details

I. General information

NPI: 1689428229
Provider Name (Legal Business Name): LIAM PATRICK ARNOLD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 11/20/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SOUTH GRAND BLVD
SAINT LOUIS MO
63104
US

IV. Provider business mailing address

1402 SOUTH GRAND BLVD ROOM M260
SAINT LOUIS MO
63104
US

V. Phone/Fax

Practice location:
  • Phone: 314-257-8000
  • Fax: 314-617-2534
Mailing address:
  • Phone: 314-617-2359
  • Fax: 314-617-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2024025708
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: