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Individual

DR. MARK MINTUN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
510 S KINGSHIGHWAY BLVD, SAINT LOUIS, MO 63110-1016
(314) 362-7092
(314) 747-4189
Mailing address
660 S EUCLID AVE, C B 8131, SAINT LOUIS, MO 63110-1010
(314) 362-7092
(314) 747-4189

Taxonomy

Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
R6C45
MO
2085N0904X
Nuclear Radiology Physician
Primary
R6C45
MO

Other

Enumeration date
10/03/2006
Last updated
08/10/2010
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