Healthcare Provider Details

I. General information

NPI: 1912565821
Provider Name (Legal Business Name): PETER C. JOHNSON MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 NAVARRE AVE STE 202
OREGON OH
43616-3276
US

IV. Provider business mailing address

2737 NAVARRE AVE STE 202
OREGON OH
43616-3276
US

V. Phone/Fax

Practice location:
  • Phone: 419-691-5222
  • Fax: 419-691-5222
Mailing address:
  • Phone: 419-691-5222
  • Fax: 419-691-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER CARL JOHNSON
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 419-691-5222