Individual
DR. JEREMY SCOTT JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
611 W. PARK ST., OB/GYN, URBANA, IL 61801-2500
(217) 383-3140
(217) 383-4966
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6792
(217) 383-4966
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036136882
IL
207V00000X
Obstetrics & Gynecology Physician
20869
OK
207V00000X
Obstetrics & Gynecology Physician
MD2007-0689
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37881582
—
NM
Enumeration date
01/12/2006
Last updated
04/21/2015
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