Individual
DR. PAUL EDWARD JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2920 MCINTYRE DR, SUITE 350, BLOOMINGTON, IN 47403-4221
(812) 332-2226
(812) 339-2934
Mailing address
2920 MCINTYRE DR, SUITE 350, BLOOMINGTON, IN 47403-4221
(812) 332-2226
(812) 339-2934
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01055492A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200427490
—
IN
01
—
M400056134
MEDICARE
IN
Enumeration date
11/18/2005
Last updated
12/17/2020
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