Healthcare Provider Details

I. General information

NPI: 1982999462
Provider Name (Legal Business Name): PHILIP L MAR M.D., PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 VISTA AVE FL 15
SAINT LOUIS MO
63110-2539
US

IV. Provider business mailing address

550 S JACKSON ST
LOUISVILLE KY
40202-1622
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-7975
  • Fax:
Mailing address:
  • Phone: 502-852-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number2019015018
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2019015018
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: