Healthcare Provider Details

I. General information

NPI: 1225039118
Provider Name (Legal Business Name): DOUGLAS EDWARD JOHNSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N MAIN ST
ULYSSES KS
67880-2135
US

IV. Provider business mailing address

4535 DRESSLER RD NW
CANTON OH
44718-2545
US

V. Phone/Fax

Practice location:
  • Phone: 620-356-1261
  • Fax: 620-356-3846
Mailing address:
  • Phone: 303-895-6371
  • Fax: 330-451-4012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0527920
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-27920
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: