MEDICARE: DR. JOHN J STEPHENS M.D.

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	2085R0202X	Diagnostic Radiology Physician	2011018257	MO
2	2085N0700X	Neuroradiology Physician	49018	TN
3	2085N0700X	Neuroradiology Physician	2011018257	MO
4	2085R0202X	Diagnostic Radiology Physician	49018	TN

Other Identifiers

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

General Provider Information

NPI Number	:	1902002744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN J STEPHENS M.D.

Provider Business Mailing Address
First Line	:	11475 OLDE CABIN RD STE 200
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-7129
Country	:	US
Telephone Number	:	314-991-8200
Fax Number	:	314-569-1787

Provider Business Practice Location Address
First Line	:	10010 KENNERLY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2106
Country	:	US
Telephone Number	:	314-525-1165
Fax Number	:

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	12/09/2025

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