NPI 1629014626

Jon Bradley Johnson, MD

Practitioner Urology Physician Monroe, LA

Practice location

Address: 2516 Broadmoor Blvd, Monroe, LA 71201-2988
Phone: (318) 387-9420
Fax: (318) 323-8216
Mailing address: 130 Desiard St Suite 355, Monroe, LA 71201-7319

Registered specialties

Urology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208800000X Licence 021605 (LA)

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Registry record

NPI: 1629014626
Entity type: Individual
Sex (as registered): Male
NPI issued: 20 Jun 2006
Record last updated: 12 Jun 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.