Provider Demographics
NPI:1629295712
Name:SAINT LOUIS UNIVERSITY DBA MARK HERBERS, M.D.
Entity Type:Organization
Organization Name:SAINT LOUIS UNIVERSITY DBA MARK HERBERS, M.D.
Other - Org Name:MARK F. HERBERS, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:REICHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-225-7908
Mailing Address - Street 1:1747 SMIZER STATION RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2784
Mailing Address - Country:US
Mailing Address - Phone:636-225-7908
Mailing Address - Fax:636-225-7497
Practice Address - Street 1:1747 SMIZER STATION RD
Practice Address - Street 2:SUITE 6
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2784
Practice Address - Country:US
Practice Address - Phone:636-225-7908
Practice Address - Fax:636-225-7497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36171208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty