MEDICARE: DARRYL L JOHNSON MD

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
1	207W00000X	Ophthalmology Physician	9808	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598765661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRYL L JOHNSON MD

Provider Business Mailing Address
First Line	:	400 EAST VAUGHN AVE
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270
Country	:	US
Telephone Number	:	318-251-0620
Fax Number	:	318-251-0621

Provider Business Practice Location Address
First Line	:	400 EAST VAUGHN AVE
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270
Country	:	US
Telephone Number	:	318-251-0620
Fax Number	:	318-251-0621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/08/2007

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