Basic Information
| Provider Information | |||||||||
| NPI: | 1780805903 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | C SCOTT MOLDEN, M.D., PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 VANCE RD | ||||||||
| Address2: | |||||||||
| City: | VALLEY PARK | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630881527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362255445 | ||||||||
| FaxNumber: | 6362255552 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 N NEW BALLAS RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631416825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362255445 | ||||||||
| FaxNumber: | 6362255552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 08/28/2007 | ||||||||
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| AuthorizedOfficialLastName: | MOLDEN | ||||||||
| AuthorizedOfficialFirstName: | C SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6362255445 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.