Provider Demographics
NPI:1417278649
Name:SUCHER, MARK GERARD I (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:GERARD
Last Name:SUCHER
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12639 OLD TESSON RD STE 115
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:314-849-0311
Mailing Address - Fax:
Practice Address - Street 1:845 N NEW BALLAS CT STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7169
Practice Address - Country:US
Practice Address - Phone:314-983-4700
Practice Address - Fax:314-692-9862
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2016009814207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1023417OtherBLUE CROSS BLUE SHIELD
MO122950121Medicare PIN