MR. Mark Samuel Johnson, PA-C MT ASCP

NPI #1568453132 in Saint Charles, Missouri

Provider Information

NPI Number: 1568453132
Entity Type: Individual
Name: MR. Mark Samuel Johnson, PA-C MT ASCP
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C MT ASCP
Enumeration Date: Nov 2, 2005
Last Updated: Mar 13, 2020

Practice Location

Address: 300 1ST CAPITOL DR
City: Saint Charles
State: Missouri
ZIP Code: 63301-2844
Phone: (636) 947-5000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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