Provider Demographics
NPI:1639174659
Name:MCGARRY, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:MCGARRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:D
Other - Last Name:MCGARRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:P O BOX 470
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63019-0470
Mailing Address - Country:US
Mailing Address - Phone:636-937-0005
Mailing Address - Fax:636-933-9494
Practice Address - Street 1:168 INDUSTRIAL DR
Practice Address - Street 2:MEDICAL VILLAGE ANNEX BUILDING
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4133
Practice Address - Country:US
Practice Address - Phone:636-937-0005
Practice Address - Fax:636-933-9494
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO358352081P0004X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200427128Medicaid
MO0500010OtherUNITED HEALTHCARE
MO130001044OtherRAILROAD MEDICARE
MO3008OtherBLUE SHIELD
MO116562OtherHEALTHLINK
MO4311996OtherAETNA
MO000005329Medicare PIN
MO200427128Medicaid