Provider Demographics
NPI:1679514145
Name:VELLINGA, JOHN ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALAN
Last Name:VELLINGA
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 1:4800 MEXICO RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1666
Mailing Address - Country:US
Mailing Address - Phone:636-936-0400
Mailing Address - Fax:636-936-2252
Practice Address - Street 1:4800 MEXICO RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1666
Practice Address - Country:US
Practice Address - Phone:636-936-0400
Practice Address - Fax:636-936-2252
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5P16207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO197791OtherBCBS
MO2000224OtherPHP
MO249776OtherHEALTHLINK
MO072246OtherFMH/EXCLUSIVE CHOICE
MO197791OtherBLUE CHOICE
MO246938112Medicaid
MO35554OtherGHP
MO35554OtherCMR
MO050055140OtherMEDICARE RAILROAD
MOA003431711815OtherTRICARE
MOF04439OtherMERCY
MO431711815OtherNALC
MO491711815Other1ST HEALTH
MO63868010001OtherCIGNA
MO2000224OtherUHC
MO431711815OtherGREATWEST
MO5339096OtherAETNA
MO6675670001Medicare NSC
MO249776OtherHEALTHLINK
MO35554OtherGHP