Provider Demographics
NPI:1295725851
Name:JOHNSON, CRAIG ALAN (DO)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:ALAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 S BLOOMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-2212
Mailing Address - Country:US
Mailing Address - Phone:765-658-2753
Mailing Address - Fax:765-655-2604
Practice Address - Street 1:115 S MURPHY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-8296
Practice Address - Country:US
Practice Address - Phone:812-442-2100
Practice Address - Fax:812-446-4409
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200853600AMedicaid
IN153869OtherRURAL HEALTH
IN200300810Medicaid
INP00416616OtherRAILROAD MEDICARE
IN200286610Medicaid
IN147180ZZMedicare PIN
H05692Medicare UPIN