Provider Demographics
NPI:1235132812
Name:JOHNSON, ALLAN CHARLES JR (DO)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:CHARLES
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:4950 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-2304
Mailing Address - Country:US
Mailing Address - Phone:814-898-2576
Mailing Address - Fax:814-899-0334
Practice Address - Street 1:4950 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-2304
Practice Address - Country:US
Practice Address - Phone:814-898-2576
Practice Address - Fax:814-899-0334
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2020-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS005863L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C31435Medicare UPIN