Provider Demographics
NPI:1477172062
Name:ARNOLD, DAVID ERIC
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ERIC
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 EXECUTIVE DR STE 111
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5608
Mailing Address - Country:US
Mailing Address - Phone:314-766-0796
Mailing Address - Fax:888-375-5410
Practice Address - Street 1:2480 EXECUTIVE DR STE 111
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5608
Practice Address - Country:US
Practice Address - Phone:314-766-0796
Practice Address - Fax:888-375-5410
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6362978282OtherMEDICARE