Provider Demographics
NPI:1992701700
Name:SUSAN S JOHNSON MD AND BRIAN L JOHNSON MD PC
Entity type:Organization
Organization Name:SUSAN S JOHNSON MD AND BRIAN L JOHNSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-442-9944
Mailing Address - Street 1:4700 FORUM BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5654
Mailing Address - Country:US
Mailing Address - Phone:573-449-4936
Mailing Address - Fax:573-449-6795
Practice Address - Street 1:103 RIPLEY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5738
Practice Address - Country:US
Practice Address - Phone:573-442-9944
Practice Address - Fax:573-442-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODB6476OtherRAILROAD MEDICARE