DR. MARK MINTUN (NPI# 1144314485) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144314485 |
| Entity Type | Individual |
| Full Name | DR. MARK MINTUN |
| Credential | MD |
| Practice Address |
510 S Kingshighway Blvd Saint Louis MO 63110-1016 |
| Mailing Address |
660 S Euclid Ave C B 8131 Saint Louis MO 63110-1010 |
| Practice Telephone | 3143627092 |
| Practice Fax Number | 3147474189 |
| Mailing Telephone | 3143627092 |
| Mailing Fax Number | 3147474189 |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2010-08-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207U00000X | Nuclear Medicine | R6C45 | MO | Allopathic & Osteopathic Physicians |
| Y | 2085N0904X |
Radiology Specialization: Nuclear Radiology |
R6C45 | MO | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306077755 | Mark William Mintun | Physician Assistant | 802 Kenyon Rd, Fort Dodge, IA 50501-5740 | 2009-08-03 |
| Street Address |
510 S KINGSHIGHWAY BLVD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63110-1016 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033107982 | Laurie L Fajardo | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2005-10-13 |
| 1902442650 | Amir Iravani Tabrizipour | Nuclear Medicine | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2019-11-18 |
| 1942850078 | Paul-robert Derenoncourt | Nuclear Medicine | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2019-09-20 |
| 1659861615 | Alexander Baireddy Reddy | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110 | 2018-05-15 |
| 1508356700 | Daniel Crawford | Student in an Organized Health Care Education/Training Program | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2018-05-14 |
| 1154826675 | Eric Weiner | Student in an Organized Health Care Education/Training Program | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2018-03-27 |
| 1447754767 | Allison L Schell | Physician Assistant | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2018-03-21 |
| 1407381262 | Philip Andrew Velez | Student in an Organized Health Care Education/Training Program | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2017-04-28 |
| 1154778959 | Jimmy Xu | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2016-05-21 |
| 1124402573 | Wei Wang | Radiology | 510 S Kingshighway Blvd, Dept Radiology, Saint Louis, MO 63110-1016 | 2015-07-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659971992 | Carrie Ellen Smith | Nurse Practitioner | Mailstop 90-00-174, One Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-10-27 |
| 1881210466 | Michelle Amanda Freilich | Internal Medicine | Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-06-19 |
| 1245856046 | Jeevin Shahi | Radiology | 3685 Vista Avenue, Center for Radiation Medicine, St. Louis, MO 63110 | 2020-06-18 |
| 1497371314 | Wilson Eduardo Rodriguez | Student in an Organized Health Care Education/Training Program | 1008 S. Spring, St Louis, MO 63110 | 2020-06-17 |
| 1578184065 | Kathryn Kay Lindsay | Registered Nurse | Saint Louis University Dept of Surgery, 3635 Vista Ave 3dt, St Louis, MO 63110 | 2020-05-06 |
| 1881232700 | Ashley Diane Pace | Nurse Practitioner | 1 Parkview Place, Shoenberg 6900, St. Louis, MO 63110 | 2019-12-11 |
| 1619520418 | Krithika Damodar Shenoy | Pathology | 660 Euclid Avenue, One Barnes Jewish Hospital Plaza, St. Louis, MO 63110 | 2019-07-20 |
| 1467912550 | Ian Ferguson | Dermatology | 660 S Euclid Ave., Cb 8123, St. Louis, MO 63110 | 2019-03-23 |
| 1760978688 | Ihab Hassanieh | Student in an Organized Health Care Education/Training Program | 33660 Vista Ave, St. Louis, MO 63110 | 2018-07-03 |
| 1336634500 | Martin K Mwangi | Pediatrics | 1 Childrens Place, 3s34, St. Louis, M, MO 63110 | 2018-06-28 |
| Find all providers in zip 63110 | ||||
| Taxonomy Code | 2085N0904X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Nuclear Radiology |
| A radiologist who is involved in the analysis and imaging of radionuclides and radiolabeled substances in vitro and in vivo for diagnosis and the administration of radionuclides and radiolabeled substances for the treatment of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538529979 | Mzs Medical Services Ltd | Radiology | 953 Delvin Dr, Saint Louis, MO 63141-8800 | 2016-02-27 |
| 1962018382 | Adeel Haq | Radiology | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2020-09-21 |
| 1679134159 | Liang Wang | Radiology | 1 Barnes Jew Hosp Plz, Saint Louis, MO 63110-1003 | 2019-06-25 |
| 1679770069 | Michael C Muzinich | Radiology | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2007-06-28 |
| 1619097441 | Jonathan E Mcconathy | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2007-03-29 |
| 1194733634 | Joseph V Cusumano | Radiology | 3915 Watson Rd, Ste. Ll2, Saint Louis, MO 63109-1251 | 2006-08-03 |
| 1952347890 | Philip O Alderson | Radiology | 1402 S Grand Blvd, M268, Saint Louis, MO 63104-1004 | 2006-06-21 |
| 1295729499 | Karen F. Goodhope | Radiology | 450 N New Ballas Rd, Ste. 250, Saint Louis, MO 63141-6835 | 2005-09-02 |
| 1972597078 | Julian N Verde | Radiology | 450 N New Ballas Rd, Ste. 250, Saint Louis, MO 63141-6835 | 2005-09-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770541013 | Nathan L Kester | Radiology | 3801 S National Ave Dept Of, Springfield, MO 65807-5210 | 2006-05-03 |
| 1306991336 | Don M. Huddleston | Radiology | 1605 Martin Springs Dr, Ste 110, Rolla, MO 65401-2982 | 2007-01-23 |
| 1992711006 | Mark L. Gates | Radiology | 70 Doctors Park, Cape Girardeau, MO 63703-4928 | 2006-07-31 |
| 1104831833 | George A. Pjura | Radiology | 70 Doctors Park, Cape Girardeau, MO 63703-4928 | 2006-07-30 |
| 1639183940 | Rajinder M. Gulati | Radiology | 70 Doctors Park, Cape Girardeau, MO 63703-4928 | 2006-07-29 |
| 1841210499 | Scott C St Amour | Radiology | 300 First Capitol Drive, St Charles, MO 63301 | 2006-07-19 |
| 1508806563 | Jefferson City Medical Group, P.C. | Radiology | 1241 W Stadium Blvd, Lower Level, Jefferson City, MO 65109-6023 | 2006-06-07 |
| 1962467738 | Anil Malhotra | Radiology | 800 Hospital Dr, Columbia, MO 65201-5275 | 2006-04-17 |
| 1316910904 | Jeffrey P. Patrick | Radiology | 1241 W Stadium Blvd, Jefferson City, MO 65109-6023 | 2006-02-13 |
| 1558334516 | Steven C. Harper | Radiology | 1241 W Stadium Blvd, Jefferson City, MO 65109-6023 | 2006-02-09 |
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| City | SAINT LOUIS |
| Zip Code | 63110 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.