Provider Demographics
NPI:1851399489
Name:JOHNSON, RICHARD WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WILLIAM
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 1:524 N ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-9712
Mailing Address - Country:US
Mailing Address - Phone:316-733-3014
Mailing Address - Fax:316-733-1240
Practice Address - Street 1:524 N ANDOVER RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-9712
Practice Address - Country:US
Practice Address - Phone:316-733-4500
Practice Address - Fax:316-733-1240
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2022-02-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
KS27062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSG64898Medicare UPIN
KS104646Medicare ID - Type Unspecified