Individual
GARRY A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 HOSPITAL DR, COLUMBIA, MO 65201-5276
(573) 882-2568
(573) 882-2226
Mailing address
PO BOX 7687, COLUMBIA, MO 65205-7687
(573) 882-2259
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
R6F64
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127254
BLUE SHIELD/BLUE CHOICE
MO
01
—
194834
HEALTHLINK
MO
01
—
2001130
UNITED HEALTHCARE
MO
05
—
202461554
—
MO
Enumeration date
04/19/2006
Last updated
01/13/2014
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