Provider Demographics
NPI:1902809692
Name:JOHNSON, DEBORAH M (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:4950 ESSEN LN STE 300
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3739
Practice Address - Country:US
Practice Address - Phone:225-757-0343
Practice Address - Fax:225-757-8354
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021976207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1446891OtherMEDICAID GROUP
LA1686760Medicaid
LA5CK94OtherMEDICARE GROUP
LA5W980CK94OtherMEDICARE GROUP NUMBER PIN
LAP00157711OtherRAILROAD MEDICARE PIN
LADB9815OtherRAILROAD MEDICARE GROUP
LA5W980Medicare PIN
LAP00157711OtherRAILROAD MEDICARE PIN
LA5208480001Medicare NSC