Provider Demographics
NPI:1396743886
Name:JOHNSON, JOHN R (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:STE #900
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3900
Practice Address - Country:US
Practice Address - Phone:502-584-7525
Practice Address - Fax:502-589-0849
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY19490207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
107150OtherNLSC/SIHO
KY2432613000OtherPASSPORT ADVANTAGE (UNIVE
KY64194905Medicaid
KY200007230OtherRAILROAD MEDICARE (SPINE
KY000000049350OtherANTHEM (UNIVERSITY ORTHOP
000051983NOtherNLS/HUMANA
IN100373880AMedicaid
3728035000OtherNLSC/PAD
KY000000049466OtherANTHEM (SPINE INSTITUTE)
000000628404OtherNLSC/ANTHEM
KY1054518OtherPASSPORT (SPINE INSTITUTE
KY2433674000OtherPASSPORT ADVANTAGE (SPINE
2521939OtherNLSC/CIGNA
50024959OtherNLSC/PHP
KYN291394OtherHARMONY
KY1049637OtherPASSPORT (UNIVERSITY ORTH
KY163722400OtherUS DEPT OF LABOR
KY200005919OtherRAILROAD MEDICARE (UNIVER
KY1054518OtherPASSPORT (SPINE INSTITUTE
IN141460DMedicare PIN
KY0235804Medicare PIN
KY1049637OtherPASSPORT (UNIVERSITY ORTH
KY200007230OtherRAILROAD MEDICARE (SPINE