Individual
MARK FOGARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7419 WATSON RD, SAINT LOUIS, MO 63119-4415
(314) 400-3360
(314) 400-3361
Mailing address
PO BOX 23340, SAINT LOUIS, MO 63156-3340
(314) 400-3360
(314) 400-3361
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
106500
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209776202
—
MO
Enumeration date
09/07/2005
Last updated
06/29/2018
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