Provider Demographics
NPI:1417066671
Name:JOHNSON, CHERYL A (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 N 1100 E
Mailing Address - Street 2:SUITE A
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2054
Mailing Address - Country:US
Mailing Address - Phone:801-855-3844
Mailing Address - Fax:801-855-3854
Practice Address - Street 1:680 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2241
Practice Address - Country:US
Practice Address - Phone:801-768-0821
Practice Address - Fax:801-768-4526
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2644691205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD0146Medicaid
UT000010871Medicare PIN
UTD0146Medicaid
UT000065223Medicare PIN