Johnson, Larry Austin

Johnson, Larry Austin is an individual health care provider with primary practice located at 225 E Jackson Ave , Jonesboro AR 72401-3119. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology. Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology is his primary health care specialty. Johnson, Larry Austin can be contacted via phone (870) 932-0639.

Contact Information

Primary practice address
225 E Jackson Ave Jonesboro AR 72401-3119
Phone: (870) 932-0639
Fax: (870) 932-0526
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X E3004 Arkansas
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X E3004 Arkansas

Profile Details

NPI number 1841292000
LBN Legal business name Johnson, Larry Austin
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2005
Last updated Nov 17th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841292000 NPPES
Missouri MEDICAID 208791806
Missouri MEDICAID 149994001

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