Individual
DR. DENISE ROBERTS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6973 OLIVE BLVD, UNIVERSITY CITY, MO 63130-2540
(314) 862-7515
(314) 862-9214
Mailing address
6973 OLIVE BLVD, UNIVERSITY CITY, MO 63130-2540
(314) 862-7515
(314) 862-9214
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
R9G45
MO
2080A0000X
Pediatric Adolescent Medicine Physician
R9G45
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202402210
—
MO
Enumeration date
12/06/2006
Last updated
12/12/2011
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