Provider Demographics
NPI:1720086747
Name:MOLDEN, C SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:C
Middle Name:SCOTT
Last Name:MOLDEN
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 1:530 VANCE RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY PARK
Mailing Address - State:MO
Mailing Address - Zip Code:63088-1527
Mailing Address - Country:US
Mailing Address - Phone:636-225-5445
Mailing Address - Fax:636-225-5552
Practice Address - Street 1:555 N NEW BALLAS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6825
Practice Address - Country:US
Practice Address - Phone:636-225-5445
Practice Address - Fax:314-432-6308
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110042155OtherRR MEDICARE
MO101330OtherHEALTHLINK
MO51321OtherGROUP HEALTH PLAN
MO20962OtherBLUE CROSS/BLUE SHIELD
MO20962OtherBLUE CROSS/BLUE SHIELD
MO311525383Medicare PIN