Provider Demographics
NPI:1760596126
Name:EDDY, MARK C (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:EDDY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1465 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1003
Mailing Address - Country:US
Mailing Address - Phone:314-268-4010
Mailing Address - Fax:314-268-6448
Practice Address - Street 1:1465 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1003
Practice Address - Country:US
Practice Address - Phone:314-577-5648
Practice Address - Fax:314-268-6448
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-01-15
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Provider Licenses
StateLicense IDTaxonomies
MO1054962080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology