Healthcare Provider Details

I. General information

NPI: 1699928432
Provider Name (Legal Business Name): GREG ANTHONY JOHNSON C.O., BOCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 S MAIN ST STE LL3
JOPLIN MO
64801-4565
US

IV. Provider business mailing address

2039 N PENELOPE LN
FAYETTEVILLE AR
72704-7206
US

V. Phone/Fax

Practice location:
  • Phone: 417-726-9964
  • Fax: 417-622-4449
Mailing address:
  • Phone: 479-305-9374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberOP00095
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberOP00095
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: