Individual
JOHN DEREK JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
180 NINTH ST, LASALLE FAMILY MEDICINE CLINIC, JENA, LA 71342-3900
(318) 992-9200
Mailing address
PO BOX 2780, LASALLE FAMILY MEDICINE CLINIC, JENA, LA 71342-2780
(318) 992-9200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
206647
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2188658
—
LA
Enumeration date
04/11/2012
Last updated
07/07/2015
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