Provider Demographics
NPI:1114930492
Name:JOHNS, TIMOTHY A (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:JOHNS
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:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213
Mailing Address - Country:US
Mailing Address - Phone:304-586-0771
Mailing Address - Fax:304-586-0799
Practice Address - Street 1:5656 S POWER RD
Practice Address - Street 2:GILBERT HOSPITAL
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85236
Practice Address - Country:US
Practice Address - Phone:480-984-2000
Practice Address - Fax:480-279-5836
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14272207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ774738Medicaid
AZ101012Medicare ID - Type Unspecified
D44072Medicare UPIN