1205195005 NPI number — DR. JOHN STEPHEN MULVAHILL M.D.

Table of content: DR. JOHN STEPHEN MULVAHILL M.D. (NPI 1205195005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205195005 NPI number — DR. JOHN STEPHEN MULVAHILL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULVAHILL
Provider First Name:
JOHN
Provider Middle Name:
STEPHEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205195005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 S. EUCLID AVE, CAMPUS BOX 8303
Provider Second Line Business Mailing Address:
WASHINGTON UNIV SCHOOL OF MEDICINE, DIV OF GESIATRICS A
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-286-2971
Provider Business Mailing Address Fax Number:
314-286-2701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10024 WATSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63126-1829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-919-2500
Provider Business Practice Location Address Fax Number:
314-919-2577
Provider Enumeration Date:
05/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  BP10043107 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: P9234 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 2015016131 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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