Provider Demographics
NPI:1124129549
Name:RUTLEDGE, JOHN PAUL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:RUTLEDGE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7508 BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2104
Mailing Address - Country:US
Mailing Address - Phone:314-616-3695
Mailing Address - Fax:314-647-1964
Practice Address - Street 1:10420 OLD OLIVE STREET ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-991-9700
Practice Address - Fax:314-991-7779
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO321592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0388770000OtherMAGELLAN
12086OtherBLUE CROSS BLUE SHIELD MO
1500116OtherUNITED HEALTH CARE UNITED
108930OtherHEALTHLINK NON PAR
MO200543403Medicaid
260014843OtherMEDICARE RAILROAD
281085OtherVALUEOPTIONS
35941OtherCMR
95266OtherFIRST HEALTH
A10906OtherMERCY HEALTH PLANS
MO200543403Medicaid
260014843OtherMEDICARE RAILROAD
281085OtherVALUEOPTIONS