Johnson, Bruce Dewayne
Johnson, Bruce Dewayne is an sole proprietor health care provider with primary practice located at 142 W 5Th St , Cookeville TN 38501-1760. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Johnson, Bruce Dewayne can be contacted via phone (931) 528-2541.Contact Information
Primary practice address
142 W 5Th St
Cookeville TN 38501-1760
Phone: (931) 528-2541
Fax: (530) 243-0445
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | MD0000040859 | Tennessee |
Profile Details
| NPI number | 1982650289 |
|---|---|
| LBN Legal business name | Johnson, Bruce Dewayne |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 26th, 2006 |
| Last updated | Jul 10th, 2015 - about 10 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 | 1982650289 | NPPES |
| Tennessee | MEDICAID | 3338289 |
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