Healthcare Provider Details

I. General information

NPI: 1922334671
Provider Name (Legal Business Name): MARK E. TRUMP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 04/18/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 3005B
SAINT LOUIS MO
63141-8266
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 3005B
SAINT LOUIS MO
63141-8266
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-7070
  • Fax: 314-251-7071
Mailing address:
  • Phone: 314-251-7070
  • Fax: 314-251-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD60115825
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA122454
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2018045706
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number94076
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: