Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2005021461 | MO |
N | 208600000X | Surgeon | 2005021461 | MO |
Y | 2086S0127X | Trauma Surgeon | 2005021461 | MO |
NPI | 1356418479 |
---|---|
Provider Name | Dr. Robert C. Johnson JR. |
First Address | Springfield, MO 65801-2580 |
Second Address | Springfield, MO 65804-2201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 19/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207197807 | (05) | MO |
G09960 | (02) | MO |