Provider Demographics
NPI:1083690671
Name:JOHNSON, DAVID E (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:M
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:USAMEDDAC BAVARIA
Mailing Address - Street 2:ATTN CREDENTIALS OFFICE UNIT 26610
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09036
Mailing Address - Country:US
Mailing Address - Phone:01149931-884-7772
Mailing Address - Fax:
Practice Address - Street 1:USAMEDDAC BAVARIA
Practice Address - Street 2:ATTN CREDENTIALS OFFICE UNIT 26610
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09036
Practice Address - Country:US
Practice Address - Phone:01149931-884-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055684A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN