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Individual

DR. BRIAN L. JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 635-5264
(573) 761-4351
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 635-5264
(573) 556-5757

Taxonomy

Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
108712
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
127908
GROUP HEALTH PLAN
MO
01
128687
ANTHEM BLUE CROSS BLUE SH
MO
01
1816637
FIRST HEALTH
MO
01
20433
HEALTHCARE USA IND
MO
01
204961809
MO CARE IND
MO
05
204961809
MO
01
434227
HEALTHLINK IND
MO
01
7034216
AETNA
MO
01
9201146
UNITED HEALTHCARE
MO
01
A002
TRICARE IND
MO
01
H12503
MERCY
MO
01
P00119749
RAILROAD MEDICARE
MO
Enumeration date
06/23/2005
Last updated
12/23/2014
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