1720122294 NPI number — CHRISTOPHER MARET M.D.P.C.

Table of content: (NPI 1720122294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720122294 NPI number — CHRISTOPHER MARET M.D.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTOPHER MARET M.D.P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720122294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3915 WATSON RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63109-1251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-647-9797
Provider Business Mailing Address Fax Number:
314-647-1665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3915 WATSON RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63109-1251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-647-9797
Provider Business Practice Location Address Fax Number:
314-647-1665
Provider Enumeration Date:
02/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARET
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
314-647-9797

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  R3C16 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00051491 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: DG6708 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com