Healthcare Provider Details

I. General information

NPI: 1568582369
Provider Name (Legal Business Name): MARK C. KORY, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16216 BAXTER RD SUITE 200
CHESTERFIELD MO
63017-4770
US

IV. Provider business mailing address

1456 HAARMAN OAK DR
CHESTERFIELD MO
63005-4286
US

V. Phone/Fax

Practice location:
  • Phone: 636-532-1000
  • Fax: 636-532-1605
Mailing address:
  • Phone: 314-504-7546
  • Fax: 636-532-7546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: VICKY KORY
Title or Position: SECRETARY, OFFICE MANAGER
Credential: RN
Phone: 314-504-7546