Healthcare Provider Details

I. General information

NPI: 1801999768
Provider Name (Legal Business Name): JOYCE D JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6744 CLAYTON RD
SAINT LOUIS MO
63117-1637
US

IV. Provider business mailing address

180 WEIDMAN RD SUITE 125
ST. LOUIS MO
63021
US

V. Phone/Fax

Practice location:
  • Phone: 314-781-5999
  • Fax: 314-781-5888
Mailing address:
  • Phone: 636-207-0277
  • Fax: 636-207-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMO 36382
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: