Johnson, Brian Alan
Johnson, Brian Alan is an individual health care provider with primary practice located at 613 Terrace Dr , Winamac IN 46996-1111. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Johnson, Brian Alan can be contacted via phone (574) 946-6644.Contact Information
Primary practice address
613 Terrace Dr
Winamac IN 46996-1111
Phone: (574) 946-6644
Fax: (574) 946-7801
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 01037880 | Indiana |
Profile Details
| NPI number | 1023012754 |
|---|---|
| LBN Legal business name | Johnson, Brian Alan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 10th, 2005 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023012754 | NPPES |
| Indiana | MEDICAID | 100210710A |
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