MEDICARE: DR. JAMES DEAN JOHNS MD

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	207Q00000X	Family Medicine Physician	35049624J	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0004260594	OTHER	OH	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	137831	OTHER	OH	ANTHEM ID
4	341753569Z	OTHER	OH	AULTCARE & PRIMETIME
5	87742	OTHER	OH	QUALCHOICE
6	0183865J	OTHER	OH	UNITED HEALTHCARE
7	341753569	OTHER	OH	OHIO HEALTH CHOICE
8	1006	OTHER	OH	SUMMACARE
9	OC03317	OTHER	OH	NATIONWIDE

General Provider Information

NPI Number	:	1770589863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES DEAN JOHNS MD

Provider Business Mailing Address
First Line	:	211 15TH ST NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44703-1704
Country	:	US
Telephone Number	:	330-455-0800
Fax Number	:	330-455-1453

Provider Business Practice Location Address
First Line	:	211 15TH ST NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44703-1704
Country	:	US
Telephone Number	:	330-455-0800
Fax Number	:	330-455-1453

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	03/01/2022

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