Provider Demographics
NPI:1306984505
Name:MAHAFFEY, BRIAN L (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
Last Name:MAHAFFEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:15945 CLAYTON RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2490
Mailing Address - Country:US
Mailing Address - Phone:636-893-1360
Mailing Address - Fax:636-893-1362
Practice Address - Street 1:15945 CLAYTON RD
Practice Address - Street 2:SUITE 210
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2490
Practice Address - Country:US
Practice Address - Phone:314-251-1556
Practice Address - Fax:636-893-1362
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2022-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO103424207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208254235Medicaid
AR154946001Medicaid
MO98585OtherAR BLUE SHIELD
MOP01317472OtherRAILROAD MEDICARE
MO98585OtherAR BLUE SHIELD
MO208254235Medicaid
MO152800203Medicare PIN