Individual
GREG R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
02001531A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000675115
ANTHEM
IN
05
—
200015220
—
IN
01
—
P00895098
R.R. MEDICARE
IN
Enumeration date
05/18/2006
Last updated
12/21/2022
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