Basic Information
| Provider Information | |||||||||
| NPI: | 1578096533 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EIGBIRE-MOLEN | ||||||||
| FirstName: | ODIANOSEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1402 S GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631041004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147577869 | ||||||||
| FaxNumber: | 3145778374 | ||||||||
| Practice Location | |||||||||
| Address1: | 10810 EXECUTIVE CENTER DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722114386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016042695 | ||||||||
| FaxNumber: | 5016042699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2017 | ||||||||
| LastUpdateDate: | 08/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 999999 | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207ZP0102X | E-15116 | AR | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.