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General NPI Number Information
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NPI Number | 1043293244
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Entity Type | Individual
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Provider Name | DAVID R JOHNSON MD
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Gender | Male
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 01/22/2009
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Provider Practice Location Address
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Address Line | 2001 W 86TH ST. ST. VINCENT EMERGENCY PHYSICIANS, INC
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City | INDPLS
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State | IN
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Zip | 46260-1902
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Country | US
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Telephone | 317-802-3140
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Fax | 317-870-0499
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Provider Business Mailing Address
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Address Line | 4685 RELIABLE PKWY ST VINCENT EMERGENCY PHYSICIANS, INC
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City | CHICAGO
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State | IL
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Zip | 60686-0046
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Country | US
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Telephone | 317-802-3140
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Fax | 317-870-0499
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01037139A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01037139
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01037139
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License Number State | IN
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