MEDICARE: SUSAN S JOHNSON MD AND BRIAN L JOHNSON MD PC

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	207R00000X	Internal Medicine Physician		MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DB6476	OTHER	MO	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1992701700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN S JOHNSON MD AND BRIAN L JOHNSON MD PC

Provider Business Mailing Address
First Line	:	4700 FORUM BLVD
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5654
Country	:	US
Telephone Number	:	573-449-4936
Fax Number	:	573-449-6795

Provider Business Practice Location Address
First Line	:	103 RIPLEY ST
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-5738
Country	:	US
Telephone Number	:	573-442-9944
Fax Number	:	573-442-5345

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	BRIAN L JOHNSON
Credential	:	MD
Telephone Number	:	573-442-9944

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/21/2022

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