Provider Demographics
NPI:1528088523
Name:BELCHER, MARK DAYTON (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAYTON
Last Name:BELCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 BRETT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DARDENNE PRAIRIE
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7338
Mailing Address - Country:US
Mailing Address - Phone:636-734-8778
Mailing Address - Fax:
Practice Address - Street 1:4116 VON TALGE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1957
Practice Address - Country:US
Practice Address - Phone:314-892-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000166660207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205218829Medicaid
MO907330069Medicare ID - Type Unspecified
MO205218829Medicaid