Provider Demographics
NPI:1396706867
Name:BRODY, ARNOLD G (MD)
Entity type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:G
Last Name:BRODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:700 VILLA CAPRI CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3604
Mailing Address - Country:US
Mailing Address - Phone:314-707-8520
Mailing Address - Fax:
Practice Address - Street 1:5535 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-3005
Practice Address - Country:US
Practice Address - Phone:314-879-6363
Practice Address - Fax:314-879-6372
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4231207Q00000X, 207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO037682931Medicaid
MO037682931Medicaid