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Individual

RICHARD KEITH JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1023 MEDICAL CENTER PKWY STE 311, SELMA, AL 36701-7740
(334) 418-6652
Mailing address
1023 MEDICAL CENTER PKWY STE 311, SELMA, AL 36701-7740
(334) 418-6652
(833) 645-0184

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
19773
MS
208600000X
Surgery Physician
2006015220
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03826375
MS
05
203735600
MO
01
209433
BLUE SHIELD
MO
01
752753
HEALTHLINK
MO
Enumeration date
07/24/2006
Last updated
02/02/2024
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