David R Johnson, MD
Individual provider Active NPI Family Medicine Physician · Indpls, IN
NPI 1043293244 · NPPES record last updated Jan 22, 2009
Key facts
- NPI
- 1043293244
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 01037139 (IN)
- Practice address
- 2001 W 86TH St.
St. Vincent Emergency Physicians, Inc
Indpls, IN 46260-1902 - Phone
- (317) 802-3140
- Fax
- (317) 870-0499
- NPI assigned
- Nov 22, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01037139 | IN | MD | Emergency Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01037139A | IN | |
| Emergency Medicine Physician | 207P00000X | 01037139 | IN | |
| Family Medicine Physician | 207Q00000X | 01037139 | IN | Yes |
Addresses
Primary practice location
2001 W 86TH St.
St. Vincent Emergency Physicians, Inc
Indpls, IN 46260-1902
Mailing address
4685 Reliable Pkwy
St Vincent Emergency Physicians, Inc
Chicago, IL 60686-0046
Phone (317) 802-3140
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200013750 | Medicaid | IN | |
| 200013730 | Medicaid | IN |
Other providers in Indpls, IN
- Cletis R Foster
- Tejuana Garnes
- Abbie Ann Grudzien
- Deidre East Guerrettaz
- Healthy Feet LLC
- Sarah Lynn Jones
- Elizabeth Anne Judd
- Joann Lichtenberg
- Bulva Lucas
- Dianne Martin
All providers in Indpls, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.