Individual
DOUGLAS J JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1777 ASHLEY CIR, BOWLING GREEN, KY 42104-3339
(270) 781-4090
(270) 842-3133
Mailing address
1777 ASHLEY CIR, BOWLING GREEN, KY 42104-3339
(270) 781-4090
(270) 842-3133
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
29380
KY
207Q00000X
Family Medicine Physician
Primary
29380
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000259189
ANTHEM BC & BS
KY
05
—
50002852
—
KY
05
—
64293806
—
KY
Enumeration date
03/01/2006
Last updated
06/30/2016
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