Individual
DR. BRIAN C JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
835 S VAN BUREN ST, GREEN BAY, WI 54301-3526
(920) 433-0111
Mailing address
225 S EXECUTIVE DR, BROOKFIELD, WI 53005-4266
(262) 787-4026
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
27681-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050059156
RAIL ROAD MEDICARE
—
05
—
31472500
—
WI
Enumeration date
11/30/2005
Last updated
12/17/2021
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