Provider Demographics
NPI:1104021773
Name:WILLIAM F. JOHNSON, MD
Entity Type:Organization
Organization Name:WILLIAM F. JOHNSON, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-477-6103
Mailing Address - Street 1:801 ST. MARY'S DR.
Mailing Address - Street 2:SUITE 205 W
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0518
Mailing Address - Country:US
Mailing Address - Phone:812-477-6103
Mailing Address - Fax:812-477-4897
Practice Address - Street 1:801 ST. MARY'S DR.
Practice Address - Street 2:SUITE 205 W
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0518
Practice Address - Country:US
Practice Address - Phone:812-477-6103
Practice Address - Fax:812-477-4897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026896207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INE05853Medicare UPIN