Provider Demographics
NPI:1801999768
Name:JOHNSON, JOYCE D (MD)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:180 WEIDMAN RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63021
Mailing Address - Country:US
Mailing Address - Phone:636-207-0277
Mailing Address - Fax:636-207-0221
Practice Address - Street 1:6744 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1637
Practice Address - Country:US
Practice Address - Phone:314-781-5999
Practice Address - Fax:314-781-5888
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO 363822080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1017094OtherCARE PARTNERS
MO202168308Medicaid
MO2058V2058OtherHCUSA
MO202168308Medicaid