Provider Demographics
NPI:1205195005
Name:MULVAHILL, JOHN STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEPHEN
Last Name:MULVAHILL
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 1:600 S. EUCLID AVE, CAMPUS BOX 8303
Mailing Address - Street 2:WASHINGTON UNIV SCHOOL OF MEDICINE, DIV OF GESIATRICS A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-286-2971
Mailing Address - Fax:314-286-2701
Practice Address - Street 1:10024 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1829
Practice Address - Country:US
Practice Address - Phone:314-919-2500
Practice Address - Fax:314-919-2577
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10043107207R00000X
TXP9234207R00000X
MO2015016131207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine