MEDICARE: GARRY A JOHNSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	R6F64	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	127254	OTHER	MO	BLUE SHIELD/BLUE CHOICE
2	194834	OTHER	MO	HEALTHLINK
3	2001130	OTHER	MO	UNITED HEALTHCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144285412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRY A JOHNSON MD

Provider Business Mailing Address
First Line	:	PO BOX 7687
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65205-7687
Country	:	US
Telephone Number	:	573-882-2259
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 HOSPITAL DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-5276
Country	:	US
Telephone Number	:	573-882-2568
Fax Number	:	573-882-2226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	01/13/2014

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