Individual
DR. LOREN MARK JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
203 W LOSEY ST, SUITE 1620, SCOTT AFB, IL 62225-5207
(618) 229-6306
Mailing address
203 W LOSEY ST, SUITE 1620, SCOTT AFB, IL 62225-5207
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101033282
VA
2083A0100X
Aerospace Medicine Physician
0101033282
VA
Other
Enumeration date
11/18/2005
Last updated
09/11/2025
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