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Individual

DR. MARK FREDERICK BLUMENTHAL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
12878 MANCHESTER RD, SUITE C, SAINT LOUIS, MO 63131-1803
(314) 966-6100
Mailing address
12878 MANCHESTER RD # C, SAINT LOUIS, MO 63131-1803
(314) 966-6100

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R7718
MO

Other

Enumeration date
03/08/2007
Last updated
03/31/2016
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