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General NPI Number Information
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NPI Number | 1437148723
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Entity Type | Individual
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Provider Name | MARK A DEEMER ATH TR
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Gender | Male
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4550 MEMORIAL DR SUITE G-100
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City | BELLEVILLE
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State | IL
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Zip | 62226-5359
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Country | US
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Telephone | 618-236-2246
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Fax | 618-236-2315
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Provider Business Mailing Address
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Address Line | PO BOX 24007
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City | BELLEVILLE
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State | IL
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Zip | 62223-9007
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Country | US
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Telephone | 618-222-9999
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Fax | 618-222-9337
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | IL
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