| Doctor Name: | DR. BRADLEY TYLER JOHNSON |
| NPI Number: | 1003010596 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 2013015493 |
| Business Practice Address: | 1229 E Seminole St Ste 520 Springfield, MO - 658042227 |
| Business Phone Number: | 4178205750 |
| Business Fax Number: | |
| Mailing Address: | Po Box 2580, SPRINGFIELD |
| State: | MO |
| Postal Code: | 658012580 |
| Phone Number: | 4178294620 |
| Fax Number: | |
| NPI Enumeration Date: | 06/11/2007 |
| NPI Last Update Date: | 10/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207YX0007X |
| License Number: | 2013015493 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Otolaryngology |
| Taxonomy Specialization: | Plastic Surgery within the Head & Neck |
| Taxonomy Definition: | An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them. |