Provider Demographics
NPI:1255321279
Name:JOHNSON, STEVEN F (M D)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:F
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2431 W MAIN ST
Mailing Address - Street 2:STE 1001
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1217
Mailing Address - Country:US
Mailing Address - Phone:334-794-2825
Mailing Address - Fax:334-793-5050
Practice Address - Street 1:2431 W MAIN ST
Practice Address - Street 2:STE 1001
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1217
Practice Address - Country:US
Practice Address - Phone:334-794-2825
Practice Address - Fax:334-793-5050
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL19950208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
F77066Medicare UPIN