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NPI Code Detail

MEDICARE: DR. CHARLES WILLIAM JOHNSON D.O.

MEDICARE:  DR. CHARLES WILLIAM JOHNSON  D.O.
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
1207Q00000XFamily Medicine Physician33630MO

General Provider Information

NPI Number : 1932444924
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES WILLIAM JOHNSON D.O.
Provider Business Mailing Address
First Line : 106 NE WOOD GLEN LN
Second Line :
City : LEES SUMMIT
State : MO
Zip : 64064-1508
Country : US
Telephone Number : 816-373-2734
Fax Number :
Provider Business Practice Location Address
First Line : 106 NE WOOD GLEN LN
Second Line :
City : LEES SUMMIT
State : MO
Zip : 64064-1508
Country : US
Telephone Number : 816-373-2734
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2012
Last Update Date : 12/03/2012

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Directions to “ DR. CHARLES WILLIAM JOHNSON D.O.” Practice Location

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