Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Mark Samuel Johnson, PA-CMTASCP

Individual provider Physician Assistant · NPI 1568453132

Mr. Mark Samuel Johnson, PA-CMTASCP is a Physician Assistant in Saint Charles, Missouri. Works from 3 locations. Licensed in Missouri.

Licensed in
MO
In the registry since
2005
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Practice location Address checks out

300 1st Capitol Dr
Saint Charles, MO 63301-2844
Phone: (636) 947-5000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 100 Medical Plz, Lake St Louis, MO 63367-1366 — (636) 625-5200
  • 11111 Wilcrest Green Dr, Houston, TX 77042-4813 — (337) 521-2836

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 2010013488 (MO)

Record details

NPI number1568453132
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-CMTASCP
Sole proprietorNo
NPI enumeratedNovember 2, 2005
Last updated in NPPESMarch 13, 2020
Certification dateMarch 13, 2020

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