Healthcare Provider Details

I. General information

NPI: 1205195005
Provider Name (Legal Business Name): JOHN STEPHEN MULVAHILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10024 WATSON RD
SAINT LOUIS MO
63126-1829
US

IV. Provider business mailing address

600 S. EUCLID AVE, CAMPUS BOX 8303 WASHINGTON UNIV SCHOOL OF MEDICINE, DIV OF GESIATRICS A
SAINT LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-919-2500
  • Fax: 314-919-2577
Mailing address:
  • Phone: 314-286-2971
  • Fax: 314-286-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10043107
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP9234
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2015016131
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: