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General NPI Number Information
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NPI Number | 1396743886
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Entity Type | Individual
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Provider Name | JOHN R. JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 210 E GRAY ST STE #900
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City | LOUISVILLE
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State | KY
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Zip | 40202-3900
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Country | US
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Telephone | 502-584-7525
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Fax | 502-589-0849
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 19490
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License Number State | KY
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