Wasserman, Mark Stanley

Wasserman, Mark Stanley is an individual health care provider with primary practice located at 965 Mattox Dr , Sullivan MO 63080-2365. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Wasserman, Mark Stanley can be contacted via phone (573) 860-6000.

Contact Information

Primary practice address
965 Mattox Dr Sullivan MO 63080-2365
Phone: (573) 860-6000
Fax: (573) 860-6016
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X R2F91 Missouri
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 036104995 Illinois

Profile Details

NPI number 1225130933
LBN Legal business name Wasserman, Mark Stanley
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 2nd, 2006
Last updated Jul 2nd, 2024 - about 4 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225130933 NPPES
Illinois MEDICAID 036104995

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