Individual
DR. JEFFREY R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1965 S FREMONT AVE, SUITE 370, SPRINGFIELD, MO 65804-2201
(417) 820-0300
(417) 882-9645
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
R1A74
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110070001
—
AR
05
—
201184728
—
MO
Enumeration date
01/30/2007
Last updated
05/13/2013
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