Provider Demographics
NPI:1801931597
Name:JOHNSON, BRIAN BISHOP (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:BISHOP
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 1:312 GRAMMONT STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201
Mailing Address - Country:US
Mailing Address - Phone:318-812-1761
Mailing Address - Fax:318-812-1755
Practice Address - Street 1:312 GRAMMONT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7457
Practice Address - Country:US
Practice Address - Phone:318-812-1761
Practice Address - Fax:318-812-1755
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA020483207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1962953Medicaid
LA1962953Medicaid
LA5R592CM62Medicare PIN
LA5R592Medicare PIN