Provider Demographics
NPI:1851731582
Name:MARINO, JOSEPH AARON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:AARON
Last Name:MARINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 720
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:MO
Mailing Address - Zip Code:65548-0720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:104 E US HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:MO
Practice Address - Zip Code:65548-7381
Practice Address - Country:US
Practice Address - Phone:417-934-2251
Practice Address - Fax:417-934-2871
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11017420A207Q00000X
MO2016010947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1851731582Medicaid