Provider Demographics
NPI:1568433951
Name:BLUCHER, MARK L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:BLUCHER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:625 S NEW BALLAS RD
Mailing Address - Street 2:SUITE R-7040
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-6970
Mailing Address - Fax:314-251-5756
Practice Address - Street 1:625 S NEW BALLAS RD
Practice Address - Street 2:SUITE R-7040
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-6970
Practice Address - Fax:314-251-5756
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-05-12
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Provider Licenses
StateLicense IDTaxonomies
MO2003024387208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209253400Medicaid
MOH53690Medicare UPIN