Provider Demographics
NPI:1285652743
Name:MANARY, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:MANARY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-2341
Mailing Address - Fax:314-454-4345
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED EMERGENCY MED
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-2341
Practice Address - Fax:314-454-4345
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-04-10
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Provider Licenses
StateLicense IDTaxonomies
MOR2E272080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207405309Medicaid