Individual
DR. LAWRENCE L JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3310 W. MAIN STREET, SUITE 115, ST. CHARLES, IL 60175
(630) 232-2885
(630) 232-9936
Mailing address
3310 W. MAIN STREET, SUITE 115, ST. CHARLES, IL 60175
(630) 232-2885
(630) 232-9936
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036 052717
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004500588
BLUE CROSS BLUE SHIELD ID
IL
Enumeration date
10/11/2006
Last updated
03/31/2017
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