Provider Demographics
NPI:1184060329
Name:DEFRODA, ELIZA LAMIN (MD)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:LAMIN
Last Name:DEFRODA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:
Other - Last Name:LAMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:ONE HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-884-8538
Practice Address - Fax:573-884-7453
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA273426208800000X
MO2021008803208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200095641Medicaid