Provider Demographics
NPI:1720113053
Name:MARCUM, JOHN D (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:MARCUM
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 1:1020 ST CLAIR PLAZA
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR
Mailing Address - State:MO
Mailing Address - Zip Code:63077
Mailing Address - Country:US
Mailing Address - Phone:636-629-6030
Mailing Address - Fax:636-629-6030
Practice Address - Street 1:1020 ST CLAIR PLAZA
Practice Address - Street 2:
Practice Address - City:ST CLAIR
Practice Address - State:MO
Practice Address - Zip Code:63077
Practice Address - Country:US
Practice Address - Phone:636-629-6030
Practice Address - Fax:636-629-6030
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3G15207K00000X
CAG38741207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A47578Medicare UPIN