Individual
DR. JOHN PATRICK SCALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
THREE SAINT ELIZABETH BLVD STE 2800, O FALLON, IL 62269-1282
(618) 233-6044
(833) 973-4218
Mailing address
THREE SAINT ELIZABETH BLVD STE 2800, O FALLON, IL 62269-1282
(618) 233-6044
(833) 973-4218
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036090218
IL
207RC0000X
Cardiovascular Disease Physician
01056859A
IN
207RC0000X
Cardiovascular Disease Physician
Primary
036128843
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036128843
—
IL
01
—
P01576857
RAILROAD
IL
Enumeration date
10/05/2006
Last updated
12/21/2021
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