Individual
JOHN P JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4376 7TH ST, MOLINE, IL 61265-6867
(309) 762-0777
Mailing address
4376 7TH ST, MOLINE, IL 61265-6867
(309) 762-0777
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085002074
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090218
HEALTH ALLIANCE
—
01
—
242060
MIDLAND'S CHOICE
IL
01
—
385000978
CONTROLLED SUBSTANCE#
IL
01
—
421060724
BILLING TAX ID FOR CHC
IA
01
—
421060724A3
JOHN DEERE HEALTH
IL
01
—
93251
IA BC/BS SEEN IN MOLINE
IA
01
—
93263
IA BC/BS SEEN IN RI
IA
01
—
IL01A3
JOHN DEERE EDI#
IL
01
—
Q02637
UPIN
—
Enumeration date
09/22/2005
Last updated
03/08/2012
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