Provider Demographics
NPI:1770993206
Name:JOHNSON, BROCK A (MD)
Entity type:Individual
Prefix:DR
First Name:BROCK
Middle Name:A
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:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-9565
Mailing Address - Fax:
Practice Address - Street 1:1729 KINNEYS LN STE 102
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3166
Practice Address - Country:US
Practice Address - Phone:740-351-0980
Practice Address - Fax:740-351-0021
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY54062207X00000X
OH35.139825207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery