Individual
DR. BRUCE E JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 RIVERSIDE CIR, ROANOKE, VA 24016-4955
(540) 224-5170
(540) 983-8229
Mailing address
3 RIVERSIDE CIR, ROANOKE, VA 24016-4955
(540) 224-5170
(540) 983-8229
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101243335
VA
207R00000X
Internal Medicine Physician
200400524
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1369G
BCBS NC
NC
05
—
891369G
—
NC
01
—
P00153978
RAILROAD MEDICARE
NC
Enumeration date
08/19/2005
Last updated
12/12/2014
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