Provider Demographics
NPI:1407967656
Name:JOHNSON, E. WILLIAM
Entity Type:Individual
Prefix:
First Name:E. WILLIAM
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-658-1277
Mailing Address - Fax:603-658-1278
Practice Address - Street 1:3 ALUMNI DR
Practice Address - Street 2:STE 204
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833
Practice Address - Country:US
Practice Address - Phone:603-658-1277
Practice Address - Fax:603-658-1278
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14554208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075197Medicaid
NH3075197Medicaid
NH14554OtherSTATE LICENSE