Provider Demographics
NPI:1689640344
Name:HOUSTON, MARK T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:HOUSTON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:15945 CLAYTON RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2490
Mailing Address - Country:US
Mailing Address - Phone:636-256-5380
Mailing Address - Fax:636-256-5396
Practice Address - Street 1:15945 CLAYTON RD
Practice Address - Street 2:SUITE 330
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2490
Practice Address - Country:US
Practice Address - Phone:636-256-5380
Practice Address - Fax:636-256-5396
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2015-07-23
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Provider Licenses
StateLicense IDTaxonomies
MOR2D71207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1689640344Medicaid
MO080134765OtherRAILROAD MEDICARE
MOC39900Medicare UPIN
MO1689640344Medicaid