Provider Demographics
NPI:1437148723
Name:DEEMER, MARK A (ATH TR)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:DEEMER
Suffix:
Gender:M
Credentials:ATH TR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24007
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-9007
Mailing Address - Country:US
Mailing Address - Phone:618-222-9999
Mailing Address - Fax:618-222-9337
Practice Address - Street 1:4550 MEMORIAL DR
Practice Address - Street 2:SUITE G-100
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5359
Practice Address - Country:US
Practice Address - Phone:618-236-2246
Practice Address - Fax:618-236-2315
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer