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General NPI Number Information
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NPI Number | 1285793356
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Entity Type | Individual
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Provider Name | DENISE ROBERTS JOHNSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 6973 OLIVE BLVD
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City | UNIVERSITY CITY
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State | MO
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Zip | 63130-2540
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Country | US
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Telephone | 314-862-7515
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Fax | 314-862-9214
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Provider Business Mailing Address
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Address Line | 6973 OLIVE BLVD
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City | UNIVERSITY CITY
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State | MO
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Zip | 63130-2540
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Country | US
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Telephone | 314-862-7515
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Fax | 314-862-9214
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | R9G45
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | R9G45
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License Number State | MO
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