MEDICARE: MR. DOUGLAS EDWARD JOHNSON DO

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	207Q00000X	Family Medicine Physician	05-27920	KS
2	207P00000X	Emergency Medicine Physician	0527920	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1316916638	OTHER	KS	NPI NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225039118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS EDWARD JOHNSON DO

Provider Business Mailing Address
First Line	:	202 W KANSAS AVE
Second Line	:
City	:	ULYSSES
State	:	KS
Zip	:	67880-2034
Country	:	US
Telephone Number	:	620-356-5870
Fax Number	:	620-356-5867

Provider Business Practice Location Address
First Line	:	202 W KANSAS AVE
Second Line	:
City	:	ULYSSES
State	:	KS
Zip	:	67880-2034
Country	:	US
Telephone Number	:	620-356-5870
Fax Number	:	620-356-5867

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	02/08/2021

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