Provider Demographics
NPI:1679514293
Name:LINK, MARK CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:LINK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:999 DIAMOND RDG
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6920
Mailing Address - Country:US
Mailing Address - Phone:573-632-5585
Mailing Address - Fax:573-635-0674
Practice Address - Street 1:1002 DIAMOND RDG
Practice Address - Street 2:SUITE 200
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6896
Practice Address - Country:US
Practice Address - Phone:573-632-5585
Practice Address - Fax:573-634-2978
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-02-10
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Provider Licenses
StateLicense IDTaxonomies
MO113486208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00322454OtherRAILROAD MEDICARE
MO209709518Medicaid
MO007014944Medicare PIN
MO209709518Medicaid