Individual
LARRY DEAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
525 BRANSON LANDING BLVD, BRANSON, MO 65616-2052
(417) 348-8646
(417) 335-7529
Mailing address
PO BOX 802843, KANSAS CITY, MO 64180-2843
(417) 269-7241
(417) 269-7567
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2018044339
MO
363A00000X
Physician Assistant
PA-263
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84690
AR BLUE CROSS
—
Enumeration date
02/20/2007
Last updated
05/26/2021
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