Provider Demographics
NPI:1710937271
Name:JOHNSON, JOHN CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 W 74TH ST
Mailing Address - Street 2:SUITE 145
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2204
Mailing Address - Country:US
Mailing Address - Phone:913-722-0020
Mailing Address - Fax:
Practice Address - Street 1:8901 W 74TH ST
Practice Address - Street 2:SUITE 145
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2271
Practice Address - Country:US
Practice Address - Phone:913-722-0020
Practice Address - Fax:913-722-6937
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS23370207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSA98431Medicare UPIN
KSB302750Medicare PIN