Individual
GREGORY WARREN MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
330 1ST CAPITOL DR, STE 390, SAINT CHARLES, MO 63301-2852
(636) 949-5760
(636) 949-0729
Mailing address
4801 WELDON SPRING PKWY, STE 300, WELDON SPRING, MO 63304-9101
(636) 949-5760
(636) 949-0729
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
102964
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17646
BLUE CROSS BLUE SHIELD
—
01
—
212683
HEALTHLINK
—
Enumeration date
06/23/2005
Last updated
01/26/2017
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