Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 111944 | MO |
NPI | 1275551699 |
---|---|
Provider Name | Dr. Jeffrey E Johnson |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 17/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
208699603 | (05) | MO |
ENROLLED | (05) | IL |