Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | MD175773 | OR |
Y | 208200000X | Surgeon | 2018019516 | MO |
Y | 208600000X | Surgeon | 2018019516 | MO |
N | 208200000X | Surgeon | MD175773 | OR |
N | 208600000X | Surgeon | MD175773 | OR |
NPI | 1144517897 |
---|---|
Provider Name | Benjamin J Johnston |
First Address | Kansas City, MO 64108-2602 |
Second Address | Kansas City, MO 64108-2640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2011 |
Last Update Date | 30/11/2020 |