Individual
JEFF KENT JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2001 W 86TH ST, INDIANAPOLIS, IN 46260-1902
(317) 338-3634
Mailing address
10330 N MERIDIAN ST # 300, INDIANAPOLIS, IN 46290-1024
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02003062A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200824870
—
IN
Enumeration date
06/28/2006
Last updated
10/06/2017
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