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Individual
DR. VINCENT L JOHNSON
Active
Individual
DR. VINCENT L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
036069759
IL
208000000X
Pediatrics Physician
036-096759
IL
208M00000X
Hospitalist Physician
Primary
036096759
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0222075
BLUE CROSS GROUP NUMBER
IL
05
—
036096759
—
IL
01
—
206147
MEDICARE GROUP NUMBER
IL
01
—
3631498336019001
CDPG HFS PAYEE ID
IL
01
—
P00656803
MEDICARE RAILROAD
IL
Enumeration date
09/09/2005
Last updated
07/19/2013
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