Healthcare Provider Details

I. General information

NPI: 1851731582
Provider Name (Legal Business Name): JOSEPH AARON MARINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E US HIGHWAY 60
MOUNTAIN VIEW MO
65548-7381
US

IV. Provider business mailing address

PO BOX 720
MOUNTAIN VIEW MO
65548-0720
US

V. Phone/Fax

Practice location:
  • Phone: 417-934-2251
  • Fax: 417-934-2871
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11017420A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2016010947
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: