Individual
GREG R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3909 NEW VISION DR, FORT WAYNE, IN 46845-1725
(260) 469-6602
(260) 969-3065
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
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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