Provider Demographics
NPI:1093757841
Name:VLAHOVICH, GARY (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:VLAHOVICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-996-7888
Mailing Address - Fax:314-996-7885
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:SUITE 214B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-996-7888
Practice Address - Fax:314-996-7885
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMOR6208207RC0000X
MOR6208207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241104207Medicaid
002013022Medicare ID - Type UnspecifiedFARMINGTON NUMBER
MO241104207Medicaid
A10620Medicare UPIN