Provider Demographics
NPI:1124023056
Name:ST. JOHN, GREGORY ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLEN
Last Name:ST. JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MEDICAL PARK PL
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8051
Mailing Address - Country:US
Mailing Address - Phone:501-625-3400
Mailing Address - Fax:501-625-3402
Practice Address - Street 1:130 MEDICAL PARK PL
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8051
Practice Address - Country:US
Practice Address - Phone:501-625-3400
Practice Address - Fax:501-625-3402
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-7977207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5J344OtherBCBS OF AR
AR060025716OtherRAILROAD MEDICARE
AR124898001Medicaid
ARF76085Medicare UPIN
AR364367YYOPMedicare PIN