Provider Demographics
NPI:1760406466
Name:JOHNSON, STEVEN M (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:300 SPRING ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3498
Mailing Address - Country:US
Mailing Address - Phone:812-282-4309
Mailing Address - Fax:812-283-8299
Practice Address - Street 1:300 SPRING ST STE 3B
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3498
Practice Address - Country:US
Practice Address - Phone:812-282-4309
Practice Address - Fax:812-283-8299
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003029A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000475298OtherANTHEM
IN351282109OtherUNITED HEALTHCARE
INP00374228OtherTRAVELERS MEDICARE
IN3490374OtherCIGNA
IN1235281OtherCHA HEALTH
IN7221680OtherAETNA
IN7221680OtherAETNA
IN3490374OtherCIGNA