Individual
DR. DWAYNE EDWARD JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
236 SIMPSON AVE, ELKHART, IN 46516-4666
(574) 584-7373
(574) 293-3744
Mailing address
148 W HIVELY AVE, SUITE 1, ELKHART, IN 46517-2191
(574) 350-2500
(574) 350-2598
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01073977A
IN
208000000X
Pediatrics Physician
28666
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000052119
ANTHEM
—
01
—
1087687
PASSPORT HEALTH PLAN
—
05
—
200287610B
—
IN
01
—
2133380
AETNA
—
01
—
2435769000
PASSPORT ADVANTAGE
—
01
—
611336483
COMMONWEALTH HEALTH ALLIA
—
05
—
642886669
—
KY
01
—
87043
FIRST HEALTH NETWORK
—
Enumeration date
11/06/2006
Last updated
11/03/2023
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