Provider Demographics
NPI:1508420647
Name:JOHNSON, BENJAMIN SCOTT (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SCOTT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E BELL ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4993
Mailing Address - Country:US
Mailing Address - Phone:920-969-1768
Mailing Address - Fax:920-267-5222
Practice Address - Street 1:515 S WASHBURN ST STE 200
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7975
Practice Address - Country:US
Practice Address - Phone:920-969-1768
Practice Address - Fax:920-267-5222
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI84229207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology