Provider Demographics
NPI:1598783243
Name:JOHNSON, WILLIAM F (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:801 SAINT MARYS 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 SAINT MARYS 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01026896207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100245890AMedicaid
IN100245890AMedicaid
INE05853Medicare UPIN