Provider Demographics
NPI:1407184930
Name:JOHNSON, DENISE L (DPM)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 HOUMA BLVD
Mailing Address - Street 2:BUILDING 6, SUITE 224
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2931
Mailing Address - Country:US
Mailing Address - Phone:504-454-2900
Mailing Address - Fax:504-454-2915
Practice Address - Street 1:3939 HOUMA BLVD
Practice Address - Street 2:BUILDING 6, SUITE 224
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2931
Practice Address - Country:US
Practice Address - Phone:504-454-2900
Practice Address - Fax:504-454-2915
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM.200051213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery