Healthcare Provider Details

I. General information

NPI: 1003173436
Provider Name (Legal Business Name): BRANDON TERON JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 NE GOODVIEW CIR
LEES SUMMIT MO
64064-1996
US

IV. Provider business mailing address

5101 COLLEGE BLVD
LEAWOOD KS
66211-1614
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-4200
  • Fax: 816-875-2598
Mailing address:
  • Phone: 816-478-4200
  • Fax: 816-875-2597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number04-40523
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2017043658
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: