Provider Demographics
NPI:1609831171
Name:MOLINA-VICENTY, HECTOR D (MD)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:D
Last Name:MOLINA-VICENTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 N GRAND BLVD # 111JC
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63106-1621
Mailing Address - Country:US
Mailing Address - Phone:314-286-6356
Mailing Address - Fax:314-286-6442
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:5TH FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-286-2635
Practice Address - Fax:314-286-2338
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9H96207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208494005Medicaid
IL$$$$$$$$$Medicaid
MO208494005Medicaid
IL$$$$$$$$$Medicaid
P00263893Medicare PIN