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General NPI Number Information
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NPI Number | 1003558305
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Entity Type | Individual
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Provider Name | AUSTIN DEAN JOHNSON MD
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Gender | Male
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Dates
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Enumeration Date | 04/08/2022
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 2211 MAYFAIR DR STE 102
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City | OWENSBORO
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State | KY
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Zip | 42301-4569
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Country | US
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Telephone | 270-688-1351
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Fax | 270-688-3420
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Provider Business Mailing Address
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Address Line | 11234 ANDERSON ST
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City | LOMA LINDA
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State | CA
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Zip | 92350-1716
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Country | US
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Telephone | 909-558-6491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 61314
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A189099
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License Number State | CA
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