Individual
DR. PHILIP JAMES JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2418 LAKE AVE, FT WAYNE, IN 46805
(260) 422-4757
(260) 422-8375
Mailing address
2418 LAKE AVE, FT WAYNE, IN 46805
(260) 422-4757
(260) 422-8375
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01023461
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000083093
PIN BCBS
IN
01
—
4062678
AETNA
IN
Enumeration date
03/05/2007
Last updated
01/31/2008
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