Healthcare Provider Details

I. General information

NPI: 1760406466
Provider Name (Legal Business Name): STEVEN M. JOHNSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SPRING ST STE 3B
JEFFERSONVILLE IN
47130-3498
US

IV. Provider business mailing address

300 SPRING ST STE 3B
JEFFERSONVILLE IN
47130-3498
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-4309
  • Fax: 812-283-8299
Mailing address:
  • Phone: 812-282-4309
  • Fax: 812-283-8299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number02003029A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: