Individual
NATHAN SAMUEL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6009 RALSTON AVE, INDIANAPOLIS, IN 46220-2353
(219) 916-6883
Mailing address
6009 RALSTON AVE, INDIANAPOLIS, IN 46220-2353
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01072715A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11015540A
IN
Other
Enumeration date
06/08/2010
Last updated
05/20/2014
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