Provider Demographics
NPI:1720122294
Name:CHRISTOPHER MARET M.D.P.C.
Entity Type:Organization
Organization Name:CHRISTOPHER MARET M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARET
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:314-647-9797
Mailing Address - Street 1:3915 WATSON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-1251
Mailing Address - Country:US
Mailing Address - Phone:314-647-9797
Mailing Address - Fax:314-647-1665
Practice Address - Street 1:3915 WATSON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1251
Practice Address - Country:US
Practice Address - Phone:314-647-9797
Practice Address - Fax:314-647-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3C16207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00051491OtherRR MEDICARE
MODG6708OtherRR MEDICARE
MODG6708OtherRR MEDICARE
MOF15729Medicare UPIN