Provider Demographics
NPI:1619356318
Name:JOHNSON, WESLEY JAVEED (DO)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:JAVEED
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
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Other - First Name:
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Mailing Address - Street 1:3535 PENTAGON BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1705
Mailing Address - Country:US
Mailing Address - Phone:937-490-2270
Mailing Address - Fax:937-490-2272
Practice Address - Street 1:3535 PENTAGON BLVD STE 320
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-1705
Practice Address - Country:US
Practice Address - Phone:937-490-2270
Practice Address - Fax:937-490-2272
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.014487208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery