Individual
DR. JOHNSON UNDERWOOD IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2800 CLAY EDWARDS DR, KANSAS CITY, MO 64116-3220
(816) 691-5201
Mailing address
PO BOX 419380 - DEPT 128, KANSAS CITY, MO 64141-6380
(913) 642-4900
(913) 381-0979
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
112408
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100299860A
—
KS
01
—
14730
CMFHP
MO
05
—
1861429979
—
MO
01
—
24439012
BCBSKC
MO
01
—
300074147
RR MEDICARE
MO
01
—
5087570
AETNA
MO
Enumeration date
06/26/2006
Last updated
12/07/2011
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