=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760406466
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN M. JOHNSON D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2006
-----------------------------------------------------
Last Update Date | 01/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 SPRING ST STE 3B
-----------------------------------------------------
City | JEFFERSONVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47130-3498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-282-4309
-----------------------------------------------------
Fax | 812-283-8299
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 SPRING ST STE 3B
-----------------------------------------------------
City | JEFFERSONVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47130-3498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-282-4309
-----------------------------------------------------
Fax | 812-283-8299
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 02003029A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------