Healthcare Provider Details

I. General information

NPI: 1215855382
Provider Name (Legal Business Name): MARC ALAN GERST JR. SNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16555 MANCHESTER RD
WILDWOOD MO
63040-1213
US

IV. Provider business mailing address

318 BEACON POINT LN
WILDWOOD MO
63040-1808
US

V. Phone/Fax

Practice location:
  • Phone: 636-232-3201
  • Fax:
Mailing address:
  • Phone: 636-232-3201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2019039981
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: