Individual
JOHN A MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12 WOLF CREEK DR, SWANSEA, IL 62226-2314
(618) 277-7912
(618) 277-7915
Mailing address
124 E FAIRWAY DR, BELLEVILLE, IL 62223-2202
(618) 304-8392
(443) 451-8601
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
01066438A
IN
2085N0700X
Neuroradiology Physician
036096843
IL
2085N0700X
Neuroradiology Physician
103379
MO
2085N0700X
Neuroradiology Physician
42628
KY
2085N0700X
Neuroradiology Physician
D0068341
MD
2085R0202X
Diagnostic Radiology Physician
01066438A
IN
2085R0202X
Diagnostic Radiology Physician
Primary
036096843
IL
2085R0202X
Diagnostic Radiology Physician
103379
MO
2085R0202X
Diagnostic Radiology Physician
42628
KY
2085R0202X
Diagnostic Radiology Physician
D0068341
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360916843
—
IL
05
—
366096843
—
IL
01
—
376069
HEALTHLINK
—
01
—
P01026934
RR MEDICARE
—
Enumeration date
05/19/2006
Last updated
08/14/2025
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