Healthcare Provider Details

I. General information

NPI: 1790709103
Provider Name (Legal Business Name): JOHN BISBEE JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 STATE ROAD 229
BATESVILLE IN
47006-6809
US

IV. Provider business mailing address

1051 STATE ROAD 229
BATESVILLE IN
47006-6809
US

V. Phone/Fax

Practice location:
  • Phone: 812-934-5924
  • Fax: 812-934-6436
Mailing address:
  • Phone: 812-934-5924
  • Fax: 812-934-6436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01049451A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: