Healthcare Provider Details

I. General information

NPI: 1942332267
Provider Name (Legal Business Name): MARK S CORMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 GRAHAM RD STE 102
FLORISSANT MO
63031-8077
US

IV. Provider business mailing address

3309 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1101
US

V. Phone/Fax

Practice location:
  • Phone: 314-206-3900
  • Fax: 314-206-3992
Mailing address:
  • Phone: 314-206-3700
  • Fax: 314-206-3708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0431293
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2010006154
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: