Provider Demographics
NPI:1922334671
Name:TRUMP, MARK E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:TRUMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:621 S NEW BALLAS RD STE 3005B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8266
Mailing Address - Country:US
Mailing Address - Phone:314-251-7070
Mailing Address - Fax:314-251-7071
Practice Address - Street 1:621 S NEW BALLAS RD STE 3005B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8266
Practice Address - Country:US
Practice Address - Phone:314-251-7070
Practice Address - Fax:314-251-7071
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60115825207X00000X
CAA122454207X00000X
MO2018045706207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8560880Medicaid
WA258042OtherL&I
WAG8888858Medicare PIN