Individual
MR. LARRY C JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 PROGRESS WAY, OWENTON, KY 40359-6032
(844) 655-6100
(502) 484-2102
Mailing address
1401 MADISON AVE, COVINGTON, KY 41011-3313
(859) 655-6100
(859) 655-6148
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
35775
KY
207Q00000X
Family Medicine Physician
Primary
35775
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64051022
—
KY
Enumeration date
07/18/2006
Last updated
12/05/2018
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