Healthcare Provider Details

I. General information

NPI: 1336189612
Provider Name (Legal Business Name): EUGENE F JOHNSON JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 HILLCREST DR
PRINCETON WV
24740-2063
US

IV. Provider business mailing address

PO BOX 634715
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 304-425-1185
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number964
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number964
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: