Individual
DR. MARY MARTIN HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6800 STATE ROUTE 162, MARYVILLE, IL 62062-8521
(618) 288-5711
(314) 977-7615
Mailing address
6800 STATE ROUTE 162, MARYVILLE, IL 62062-8521
(618) 288-5711
(314) 977-7615
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
036137460
IL
207ZC0500X
Cytopathology Physician
R1J04
MO
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036137460
IL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
04-21754
KS
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
R1J04
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100257620A
—
KS
01
—
14731031
KS CITY BCBS
—
05
—
208616508
—
MO
01
—
705958
KS BCBS
KS
Enumeration date
04/10/2006
Last updated
01/26/2023
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