Provider Demographics
NPI:1477604817
Name:BOX, MARK S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:BOX
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Gender:M
Credentials:MD
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Mailing Address - Street 1:12639 OLD TESSON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:913-563-6644
Mailing Address - Fax:816-943-6122
Practice Address - Street 1:1010 CARONDELET DR
Practice Address - Street 2:SUITE 224A
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4859
Practice Address - Country:US
Practice Address - Phone:913-563-6644
Practice Address - Fax:816-943-6122
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2021-03-22
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Provider Licenses
StateLicense IDTaxonomies
KS04-26764207RR0500X
MOR1J62207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H394498Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
MOE48176Medicare UPIN