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DWAYNE JOHNSON MD PSC NPI 1689701542


NPI Information

NPI: 1689701542
Provider Name: DWAYNE JOHNSON MD PSC

Doing Business As: STRATHMOOR PEDIATRICS

Classification: Pediatrics - 208000000X
Entity Type: Organization
Address:
2211 MEADOW DR
LOUISVILLE, KY
ZIP 40218
Phone: (502) 458-2577
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DWAYNE JOHNSON MD PSC is a pediatrics in Louisville, KY. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. DWAYNE JOHNSON MD PSC NPI is 1689701542. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Strathmoor Pediatrics.

The provider's business location address is:

2211 MEADOW DR
LOUISVILLE, KY
ZIP 40218-330
Phone: (502) 458-2577
Fax: (502) 454-0105

The provider's authorized official is Dwayne Edward Johnson .
The authorized official title is President and has the following contact phone number (502) 458-2577.

The enumeration date for this NPI number is 2/27/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatrics28666KENTUCKYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
16594322700MEDICAIDKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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