Provider Demographics
NPI:1376637827
Name:JOHNSON, ALLEN C (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:1034 NORTH 500 WEST
Practice Address - Street 2:UTAH VALLEY REGIONAL MEDICAL CENTER
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT78-162765-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1502954OtherUMWA
UT8597445OtherWORKERS COMP
UTQM0000075886OtherALTIUS
UT107006656101OtherIHC
UT2090168OtherUNITED HEALTHCARE
UT35800OtherDESERET MUTUAL
UT53248OtherHEALTHY U
AZ820656Medicaid
UTPRA01603OtherMOLINA
NV002082286Medicaid
UT870545614JO2OtherEDUCATORS MUTUAL
UT37795OtherPEHP
ID806156900Medicaid
WY118887900Medicaid
UT8597445OtherWORKERS COMP
UTQM0000075886OtherALTIUS
AZ820656Medicaid