MEDICARE: DEBORAH M JOHNSON M.D.

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	207RH0003X	Hematology & Oncology Physician	021976	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	5CK94	OTHER	LA	MEDICARE GROUP
4	5W980CK94	OTHER	LA	MEDICARE GROUP NUMBER PIN
5	P00157711	OTHER	LA	RAILROAD MEDICARE PIN
6	DB9815	OTHER	LA	RAILROAD MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902809692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH M JOHNSON M.D.

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	225-765-5727
Fax Number	:	225-765-9196

Provider Business Practice Location Address
First Line	:	4950 ESSEN LN STE 300
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3739
Country	:	US
Telephone Number	:	225-757-0343
Fax Number	:	225-757-8354

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/26/2021

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Directions to “ DEBORAH M JOHNSON M.D.” Practice Location

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