Provider Demographics
NPI:1679515415
Name:AST, MARTIN B (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:B
Last Name:AST
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 1:10 HOSPITAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1659
Mailing Address - Country:US
Mailing Address - Phone:636-916-7272
Mailing Address - Fax:
Practice Address - Street 1:10 HOSPITAL DR STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1659
Practice Address - Country:US
Practice Address - Phone:636-916-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO101425207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208054700Medicaid
MO208054700Medicaid
G02434Medicare UPIN
005013022Medicare ID - Type UnspecifiedFARMINGTON NUMBER