Individual
MARK R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 N 8TH ST, SPRINGFIELD, IL 62701-1041
(217) 545-0702
(217) 545-5834
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-7578
(217) 545-1884
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
036-093433
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093433
—
IL
Enumeration date
12/07/2005
Last updated
11/17/2020
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