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NPI Code Detail

MEDICARE: CRAIG ALAN JOHNSON D.O.

MEDICARE:   CRAIG ALAN JOHNSON  D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician02002070IN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P00416616OTHERINRAILROAD MEDICARE

Other Identifiers

General Provider Information

NPI Number : 1295725851
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRAIG ALAN JOHNSON D.O.
Provider Business Mailing Address
First Line : 1542 S BLOOMINGTON ST
Second Line :
City : GREENCASTLE
State : IN
Zip : 46135-2212
Country : US
Telephone Number : 765-658-2753
Fax Number : 765-655-2604
Provider Business Practice Location Address
First Line : 115 S MURPHY AVE
Second Line : SUITE A
City : BRAZIL
State : IN
Zip : 47834-8296
Country : US
Telephone Number : 812-442-2100
Fax Number : 812-446-4409
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2005
Last Update Date : 12/10/2024

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Directions to “ CRAIG ALAN JOHNSON D.O.” Practice Location

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