Individual
GREGORY LOUIS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
700 N WESTHAVEN DR, OSHKOSH, WI 54904-6947
(920) 456-4030
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100213489
—
WI
Enumeration date
07/07/2020
Last updated
04/03/2024
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