MEDICARE: DR. ANTHONY OMAVUAYE ODIBO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	2021013428	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700889516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY OMAVUAYE ODIBO MD

Provider Business Mailing Address
First Line	:	PO BOX 60352
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63160-0352
Country	:	US
Telephone Number	:	314-454-8181
Fax Number	:	314-747-1429

Provider Business Practice Location Address
First Line	:	4901 FOREST PARK AVE
Second Line	:	DIV OBGYN MFM AND US, STE 710
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1495
Country	:	US
Telephone Number	:	314-454-8181
Fax Number	:	314-747-1429

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	04/25/2024

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