Provider Demographics
NPI:1467565754
Name:JOHNSON, GREGORY J (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-0460
Mailing Address - Country:US
Mailing Address - Phone:307-324-2221
Mailing Address - Fax:
Practice Address - Street 1:2221 W ELM ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-0460
Practice Address - Country:US
Practice Address - Phone:307-324-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3772A207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY102833200Medicaid
WY185872500OtherGROUP FED WRK COMP
WY1399310OtherUMWA
WY107205600Medicaid
WY107205600Medicaid
WY185872500OtherGROUP FED WRK COMP
WY1399310OtherUMWA
WY930000867Medicare ID - Type UnspecifiedRR MEDICARE
WY305768Medicare ID - Type Unspecified
WYCC7577Medicare ID - Type UnspecifiedGROUP RR MEDICARE