MEDICARE: DR. ROY CARL ST JOHN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	35054825S	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	290013646	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558348839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY CARL ST JOHN MD

Provider Business Mailing Address
First Line	:	788 MOUNT VERNON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43203-1408
Country	:	US
Telephone Number	:	614-457-4570
Fax Number	:	614-457-3777

Provider Business Practice Location Address
First Line	:	788 MOUNT VERNON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43203-1408
Country	:	US
Telephone Number	:	614-457-4570
Fax Number	:	614-457-3777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	03/29/2023

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