Individual
DOUGLAS ROSS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
234 GOODMAN ST, CINCINNATI, OH 45219-2364
(513) 584-3832
(513) 584-3807
Mailing address
PO BOX 636256 CENTRAL CREDENTIALING, CINCINNATI, OH 45263-6256
(513) 585-5507
(513) 585-5511
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
35 121319
OH
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
35121319
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220033608
RR MEDICARE PIN#
KY
01
—
37903705
MEDICAID LAB GROUP#
KY
01
—
4000501
MEDICARE LAB GROUP#
KY
05
—
64064181
—
KY
01
—
CB 5773
RR GROUP#
KY
Enumeration date
07/14/2006
Last updated
12/12/2017
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