John D Marcum, MD
Individual provider Active NPI Allergy & Immunology Physician · St Clair, MO
NPI 1720113053 · NPPES record last updated Jun 26, 2014
Key facts
- NPI
- 1720113053
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Allergy & Immunology Physician 207K00000X
- License
- R3G15 (MO)
- Practice address
- 1020 St Clair Plaza
St Clair, MO 63077 - Phone
- (636) 629-6030
- Fax
- (636) 629-6030
- NPI assigned
- Feb 23, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G38741 | CA | MD | Allergy & Immunology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician | 207K00000X | R3G15 | MO | Yes |
| Allergy & Immunology Physician | 207K00000X | G38741 | CA |
Addresses
Primary practice location
1020 St Clair Plaza
St Clair, MO 63077
Mailing address
1020 St Clair Plaza
St Clair, MO 63077
Phone (636) 629-6030
Other providers in St Clair, MO
- Kirk E. Brockman M.D. Dba St. Clair Medical Center
- Sheri Knight
- Susan Elizabeth Lindemann
- Charlotte A Liston
- Living Well Home Care, LLC
- Taylor Alexis Martin
- Dennis J MC Coy
- Medley Pharmacy Inc
- Medley Pharmacy Inc.
- Leah Anne Miles
All providers in St Clair, MO · Allergy & Immunology Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.