Individual
ERIC J JOHANNESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1 HOSPITAL DR, COLUMBIA, MO 65212-0001
(573) 882-1201
(573) 884-4612
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 882-3300
(573) 884-0943
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
2012020845
MO
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
2012020845
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
812
NE STATE LICENSE
NE
Enumeration date
08/22/2007
Last updated
08/07/2024
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