Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 036156623 | IL |
N | 207T00000X | Neurosurgeon | 2019024514 | MO |
NPI | 1013273580 |
---|---|
Provider Name | Stephen J Johans |
First Address | Saint Louis, MO 63141-8657 |
Second Address | Saint Peters, MO 63376-1690 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 03/02/2022 |