Provider Demographics
NPI:1245855089
Name:JOHNSON, TAYLOR JO (DO)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:JO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50302-0424
Mailing Address - Country:US
Mailing Address - Phone:515-875-9255
Mailing Address - Fax:515-875-9223
Practice Address - Street 1:1025 SE TALLGRASS LANE STE 250
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263
Practice Address - Country:US
Practice Address - Phone:515-875-8300
Practice Address - Fax:515-875-8201
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAR-11924207Q00000X
IADO-06307207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine