Healthcare Provider Details

I. General information

NPI: 1851399489
Provider Name (Legal Business Name): RICHARD WILLIAM JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date: 03/21/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

524 N ANDOVER RD
ANDOVER KS
67002-9712
US

IV. Provider business mailing address

524 N ANDOVER RD
ANDOVER KS
67002-9712
US

V. Phone/Fax

Practice location:
  • Phone: 316-733-4500
  • Fax: 316-733-1240
Mailing address:
  • Phone: 316-733-3014
  • Fax: 316-733-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27062
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: