MEDICARE: DR. MARK STEGMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	MD057842L	PA
2	207V00000X	Obstetrics & Gynecology Physician	110977	MO

General Provider Information

NPI Number	:	1760475164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK STEGMAN M.D.

Provider Business Mailing Address
First Line	:	10010 KENNERLY RD
Second Line	:	ATTN CREDNETIALING
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2106
Country	:	US
Telephone Number	:	314-525-1000
Fax Number	:	314-543-6836

Provider Business Practice Location Address
First Line	:	10010 KENNERLY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2106
Country	:	US
Telephone Number	:	314-525-1020
Fax Number	:	314-525-1387

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/01/2016

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