Provider Demographics
NPI:1912565821
Name:PETER C. JOHNSON MD
Entity Type:Organization
Organization Name:PETER C. JOHNSON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-691-5222
Mailing Address - Street 1:2737 NAVARRE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3276
Mailing Address - Country:US
Mailing Address - Phone:419-691-5222
Mailing Address - Fax:419-691-5222
Practice Address - Street 1:2737 NAVARRE AVE STE 202
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3276
Practice Address - Country:US
Practice Address - Phone:419-691-5222
Practice Address - Fax:419-691-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty