Provider Demographics
NPI:1972880268
Name:JOHNSON, LEROY (MD)
Entity Type:Individual
Prefix:
First Name:LEROY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 E 5TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1641
Mailing Address - Country:US
Mailing Address - Phone:810-406-4246
Mailing Address - Fax:810-424-6029
Practice Address - Street 1:2900 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-4452
Practice Address - Country:US
Practice Address - Phone:810-789-9141
Practice Address - Fax:810-789-9222
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033852207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology