Individual
DR. JOHN B COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2821 N BALLAS RD, SUITE 165, SAINT LOUIS, MO 63131-2321
(314) 995-9988
(866) 847-8598
Mailing address
2821 N BALLAS RD, SUITE 165, SAINT LOUIS, MO 63131-2321
(314) 995-9988
(866) 847-8598
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R9162
MO
207RR0500X
Rheumatology Physician
R9162
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112155277
RAILROAD MEDICARE
—
01
—
130260
GHP
—
01
—
2154714
AETNA SPECIALIST
—
01
—
5502
BLUE CROSS BLUE SHIELD MO
—
01
—
87043
FIRST HEALTH
—
01
—
951692
AETNA
—
Enumeration date
08/20/2006
Last updated
07/15/2013
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