Individual
DUANE P JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
12404 LIMA CROSSING DR, FORT WAYNE, IN 46818-0202
(260) 478-4201
(260) 458-3248
Mailing address
12404 LIMA CROSSING DR, FORT WAYNE, IN 46818-0202
(260) 478-4201
(260) 458-3248
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02003311A
IN
207Q00000X
Family Medicine Physician
34.009629
OH
207Q00000X
Family Medicine Physician
OS16751
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111360400
—
FL
05
—
200942660
—
IN
05
—
2968963
—
OH
Enumeration date
08/10/2006
Last updated
04/01/2024
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