Individual
GLENN T. JOHNSON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
225 CROSSLAKE DR, EVANSVILLE, IN 47715-8198
(812) 477-1558
Mailing address
225 CROSSLAKE DR, EVANSVILLE, IN 47715-8198
(812) 477-1558
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
1048654
IN
207XS0106X
Orthopaedic Hand Surgery Physician
1048654
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200238020A
—
IN
Enumeration date
07/08/2005
Last updated
06/23/2017
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