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Individual

MR. JOHN ROBERT JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
3300 WELTY RD, LUCAS, OH 44843-9729
(419) 566-4152
(419) 842-3875
Mailing address
PO BOX 14806, COLUMBUS, OH 43214-0806
(614) 261-3723
(614) 447-9593

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN140884
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000187654
ANTHEM
05
0909726
OH
01
430062329
MEDICARE RAILROAD
Enumeration date
05/15/2006
Last updated
07/30/2013
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