Provider Demographics
NPI:1093713109
Name:JOHNSON, DONALD F (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:F
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 1:114 W. 11TH STREET
Mailing Address - Street 2:HMS MED SQUARE
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061
Mailing Address - Country:US
Mailing Address - Phone:575-388-1511
Mailing Address - Fax:575-388-3465
Practice Address - Street 1:114 W 11TH ST
Practice Address - Street 2:HMS MED SQUARE
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5136
Practice Address - Country:US
Practice Address - Phone:575-388-1511
Practice Address - Fax:575-388-3465
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96-80208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMJ2516Medicaid
NMJ2516Medicaid