Provider Demographics
NPI:1225367337
Name:ST CLAIR ALLERGY-ASTHMA
Entity Type:Organization
Organization Name:ST CLAIR ALLERGY-ASTHMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARCUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-629-6030
Mailing Address - Street 1:13025 PAGADA PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1931
Mailing Address - Country:US
Mailing Address - Phone:636-629-6030
Mailing Address - Fax:636-629-6030
Practice Address - Street 1:1020 ST. CLAIR PLAZA
Practice Address - Street 2:
Practice Address - City:ST. CLAIR
Practice Address - State:MO
Practice Address - Zip Code:63077
Practice Address - Country:US
Practice Address - Phone:636-629-6030
Practice Address - Fax:636-629-6030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3G15174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty