Individual
DR. MARK STANLEY WASSERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
965 MATTOX DR, SULLIVAN, MO 63080-2365
(573) 860-6000
(573) 860-6016
Mailing address
PO BOX 959318, SAINT LOUIS, MO 63195-9318
(573) 756-6751
(573) 756-6807
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
036104995
IL
207V00000X
Obstetrics & Gynecology Physician
Primary
R2F91
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104995
—
IL
Enumeration date
09/02/2006
Last updated
09/17/2025
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