Healthcare Provider Details

I. General information

NPI: 1528050077
Provider Name (Legal Business Name): WILLIAM TODD JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NE MULBERRY ST STE 200
LEES SUMMIT MO
64086-6017
US

IV. Provider business mailing address

301 NE MULBERRY ST STE 200
LEES SUMMIT MO
64086-6017
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-1007
  • Fax: 816-524-1988
Mailing address:
  • Phone: 816-524-1007
  • Fax: 816-524-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number103076
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0427384
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: