Provider Demographics
NPI:1104843663
Name:GREGORY, MARK H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:GREGORY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:555 N NEW BALLAS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6884
Mailing Address - Country:US
Mailing Address - Phone:314-872-8470
Mailing Address - Fax:314-872-8472
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:314-872-8470
Practice Address - Fax:314-872-8472
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-03-19
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Provider Licenses
StateLicense IDTaxonomies
MO100578207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO920674500Medicaid
MO920674500Medicaid