Individual
DR. DWAYNE EDWARD JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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