Healthcare Provider Details

I. General information

NPI: 1124129549
Provider Name (Legal Business Name): JOHN PAUL RUTLEDGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10420 OLD OLIVE STREET ROAD SUITE 202
ST. LOUIS MO
63141
US

IV. Provider business mailing address

7508 BIG BEND BLVD
SAINT LOUIS MO
63119-2104
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-9700
  • Fax: 314-991-7779
Mailing address:
  • Phone: 314-616-3695
  • Fax: 314-647-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number32159
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: