Individual
DR. ANTON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 E CARPENTER ST, DEPARTMENT OF RADIOLOGY, SPRINGFIELD, IL 62702-5324
(217) 544-6464
(217) 525-5671
Mailing address
111 OAKWOOD RD, EAST PEORIA, IL 61611-1853
(309) 740-4272
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
036095564
IL
2085R0202X
Diagnostic Radiology Physician
036-095564
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300073513
RR MEDICARE
IL
01
—
300076409
RR MEDICARE
IL
05
—
36095564
—
IL
Enumeration date
08/16/2006
Last updated
01/03/2024
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