Individual
KEVIN JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12303 DE PAUL DR, BRIDGETON, MO 63044-2512
(314) 344-6000
(314) 344-6840
Mailing address
1836 LACKLAND HILL PKWY, ATTN: CREDENTIALING OFFICE, SAINT LOUIS, MO 63146-3572
(314) 989-0300
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
R7E11
MO
Other
Enumeration date
05/30/2006
Last updated
07/09/2007
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