Individual
DR. BRIAN L. MAHAFFEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15945 CLAYTON RD, SUITE 210, BALLWIN, MO 63011-2490
(314) 251-1556
(636) 893-1362
Mailing address
15945 CLAYTON RD, SUITE 210, BALLWIN, MO 63011-2490
(636) 893-1360
(636) 893-1362
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
103424
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154946001
—
AR
05
—
208254235
—
MO
01
—
98585
AR BLUE SHIELD
MO
01
—
P01317472
RAILROAD MEDICARE
MO
Enumeration date
02/01/2007
Last updated
08/30/2022
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