MEDICARE: DR. NELSON EDWIN JOHNSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	35506	MO
2	171W00000X	Contractor	35506	MO

General Provider Information

NPI Number	:	1508849118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NELSON EDWIN JOHNSON MD

Provider Business Mailing Address
First Line	:	3800 BLUE PKWY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64130-2866
Country	:	US
Telephone Number	:	816-923-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 BLUE PKWY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64130-2866
Country	:	US
Telephone Number	:	816-923-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	09/19/2019

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