Provider Demographics
NPI:1417915794
Name:JOHNSON, DONNA DEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:DEE
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 1:1001 HORSEBARN ROAD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758
Mailing Address - Country:US
Mailing Address - Phone:479-273-7700
Mailing Address - Fax:479-464-7734
Practice Address - Street 1:1001 HORSEBARN ROAD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758
Practice Address - Country:US
Practice Address - Phone:479-273-7700
Practice Address - Fax:479-464-7734
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7490208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5J107Medicare ID - Type Unspecified
AR123378001Medicaid
ARF57764Medicare UPIN