Johnson, Mark R
Johnson, Mark R is an individual health care provider with primary practice located at 301 N 8Th St , Springfield IL 62701-1041. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Pulmonology, which is considered as his primary health care specialty. Johnson, Mark R can be contacted via phone (217) 545-0702.Contact Information
Primary practice address
301 N 8Th St
Springfield IL 62701-1041
Phone: (217) 545-0702
Fax: (217) 545-5834
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatric Pulmonology | 2080P0214X | 036-093433 | Illinois |
Profile Details
| NPI number | 1205811775 |
|---|---|
| LBN Legal business name | Johnson, Mark R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 7th, 2005 |
| Last updated | Nov 17th, 2020 - about 4 years ago |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1205811775 | NPPES |
| Illinois | MEDICAID | 036093433 |
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