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NPI Code Detail

MEDICARE: JEFFREY JOHN JOHNSON MD

MEDICARE: JEFFREY JOHN 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
1207Q00000XFamily Medicine PhysicianMD-050714-LPA

General Provider Information

NPI Number : 1659331775
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY JOHN JOHNSON MD
Provider Business Mailing Address
First Line : 600 CAISSON HILL RD
Second Line :
City : FORT RILEY
State : KS
Zip : 66442-5037
Country : US
Telephone Number : 785-239-7155
Fax Number : 785-239-7364
Provider Business Practice Location Address
First Line : 600 CAISSON HILL RD
Second Line :
City : FORT RILEY
State : KS
Zip : 66442-5037
Country : US
Telephone Number : 785-239-7155
Fax Number : 785-239-7364
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 01/07/2009

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